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CBL > MSK CBL > Flashcards

MSK CBL Flashcards

1
Q

Cardinal features of OA

A

Pain aggrevated by movement and relieved by rest

Pain aching in character and poorly localised

Muscle spasms around the joint

Stiffness waking in the morning

Joint deformity and wasting of associated muscles

Joint swelling

Localised tenderness

Palpable ostephytes and crepitus

Limp or antalgic gate

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2
Q

Tests to confirm OA

A

X ray and blood tests

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3
Q

What would x-ray show in OA?

A

Loss of joint space
Subchondral sclerosis
Bone cysts
Osteophytes at lateral margin of joint

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4
Q

Which blood tests would be done in OA and what would the results be?

A

FBC - normal
ESR, CRP - normal
RF, anti-nuclear factor - negative
Calcium,phosphate, alkaline phosphatase - normal

Secondary OA abnormalities may include - high levels uric acid (gout) or alkaline phosphatase (pagets)

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5
Q

Mx of OA

A

Pain relief - analgesics and anti-inflammatories

Increase mobilisation - phsyio

Reduce load - weight loss, walking stick

Surgical - osteotomy, arthrodesis, joint replacement

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6
Q

Osteotomy

A

Can relieve pain - may change mechanical axis of joint to allow weight bearing on the part of the articular surface which isn’t affected

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7
Q

Arthrodesis

A

Best performed when adjacent joints are relatively unaffected. May be considered in young px whom a joint replacement may fail.

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8
Q

Joint replacement

A

Remains best tx for OA of hip and knee

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9
Q

6 features of a synovial joint

A

Smooth articular cartilage at bone ends

Joints surrounded by connective tissue capsule

Joint cavity

Synovial membrane

Capsule reinforced by ligaments

Joint capable of movement

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10
Q

Macroscopical pathological features in OA

A

Subarticular cysts

Osteophytes at joint margin

Sclerosis of subchondral bone

Loss of articular cartilage with eburnation of surface

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11
Q

Microscopical pathological features in OA

A

Fissuring, flaking then full thickness loss of articular cartilage

subarticular cysts

osteophytes at joint margin

sclerosis of subchondral bone

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12
Q

OA cartilage

A

Increased water content, alterations in proteoglycans, collagen abnormalities, binding of proteins to hyaluronic acid

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13
Q

Changes in synovium in OA

A

Detritus synovitis - flakes of bone and cartilage broken off from damaged joint embed in synovium = mild villous hyperplasia and chronic inflammation

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14
Q

Causes of OA

A

Primary OA

Secondary OA - high intensity impact, previous joint sepsis, charcot’s joint, paget’s disease, avascular necrosis

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15
Q

Inv for RA

A 
Haematology - 
FBC
Blood film
Haematinics
LFT's
Immunology - 
Autoantibodies (ANA, RF, complement)
Immunoglobulins
Serum protein electrophoresis
CRP
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16
Q

What results would be expected from blood tests in RA?

A

FBC - low haem, elevated ESR
Blood film - anaemia of chronic disease
Haematinics - depends on form of anaemia
LFTS - normal, mildly elevated alkaline phosphatase and maybe gamma GT

17
Q

Results expected from immunology in RA?

A

Autoantibodies -
ANA - negative
RF - positive
Complement - normal

Immunoglobulins -
Increase IgG and IgA, normal IgM

CRP high

Anti CCP antibodies

18
Q

X ray changes in RA

A

Periarticular osteopenia
Periarticular erosions
soft tissue swelling around metacarpo-pharyngeal joints

19
Q

Histological changes in RA

A 
Villous architecture abnormalities
Synovial lining hyperplasia
Fibrin exudation
Chronic inflammation with lymphoid aggregates and plasma cells
Pannus destroying cartilage
20
Q

Pathogenesis of RA

A

Joint swelling due to active synovities

Synovium full of macrophages, T lymphocytes and plasma cells (producing RF)

Macrophages activated - proinflamm cytokines e.g. TNF, IL-1 and IL-6 activate enzymes

Pannus forms and destroys cartilage and bone

21
Q

Which other systems can be affected by RA?

A

CVS - pericarditis, myocarditis, vasculitis

Resp - pleuritis, pulmonary fibrosis

Haem - anaemia, splenomegaly

22
Q

RA mx

A

NSAIDs

DMARDS - methotrexate

Corticosteroids - intra-articular, IM or oral often used until DMARDs take effect

Biological - anti TNF (infliximab), rituximab, tociluzimab

23
Q

Surgical interventions for RA

A

Tendon repair

Synovectomy

Joint replacement

Joint fusion

CBL (9 decks)

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