MSK conditions Flashcards
What are some red flags for joint pain?
Limping Not weight bearing Hot, inflamed or swollen joint Fever Systemic symptoms (tachycardia, tachypnoea)
What joint condition is acute, can deteriorate very quickly and needs to be immediately treated?
Septic arthritis
What investigation can be done if septic arthritis is suspected?
Joint aspiration and culture
How is septic arthritis treated?
Joint aspiration and culture to find specific abx
Drainage of the joint
Analgesia
Steroid injection to help pain possibly
What symptoms will someone with rheumatoid arthritis classically present with?
Symmetrical small joint pain (joints are tender and erythematous)
Stiffness of joints
Pain worse in the morning, gets better during the day
MCP joints most commonly affected
What investigations should you do if you suspect rheumatoid arthritis?
ESR/CRP (inflammatory markers)
Rheumatoid factor
anti-CCP antibody
Xrays
What are the classic features of rheumatoid arthritis that you might see on x ray?
Bony erosions Deformity (ulnar deviation) Loss of joint space Osteopenia or osteoporosis Soft tissue swelling
How would you manage rheumatoid arthritis?
Short course steroids (to induce remission) DMARDs (eg methotrexate) Biologics (tnf alpha blockers) NSAIDs Physiotherapy
What is ankylosing spondylitis?
A chronic inflammatory arthropathy that mainly affects the sacroliliac joints
Is ankylosing spondylitis mechanical or inflammatory?
Inflammatory
What is the difference between ankylosing spondylitis and axial spondyloarthropathy?
Axial spondyloarthropathy= only affects the axial skeleton
Ankylosing spondylitis= may have other symptoms like uveitis
What symptoms will someone with ankylosing spondylitis classically present with?
Recurrent back pain Pain worse in the morning Pain is worse with rest and improves with exercise Pain wakes people up at night Buttock pain Anterior uveitis
What criteria must someone meet for referral to rheumatology for ankylosing spondylitis?
Under age of 45 with back pain for longer than 3 months
Pain is inflammatory not mechanical
Pain is worse in the morning then improves
Pain wakes them up in the second half of the night
Pain is better with exercise
Pain if relieved within 48 hrs of NSAID use
Current or past psoriasis
Current or past arthritis
Who is more likely to get ankylosing spondylitis?
Male sex
Young adults
Those with family history
What investigations might be done for ankylosing spondylitis? What would the results be
Bloods- ESR and CRP may be raised
HLA B27
X rays of the sacroiliac joints- may see ankylosis, sclerosis (thickening of the bone), erosion, sacroilitis
MRI may be done to look for inflammation of the tissue where it may not be visible on x ray
How is ankylosing spondylitis managed?
Non pharmacological= exercises/stretches
Pharmacological= NSAIDs, if pain is still not managed add paracetamol/codeine, DMARDs, TNF alpha inhibitors
What is ankylosis?
Fusion of the joints
What are complications of ankylosing spondylitis?
Spinal fusion which results in severe disability
What symptom in ankylosing spondylitis warrants an immediate referral to rheumatology?
Anterior uveitis
What is meant by parenchymal lung tissue?
Functional lung tissue
What is sarcoidosis?
A chronic granulomatous disorder wherein there is an accumulation of lymphocytes and macrophages most often in the lungs, and they form non caseating granulomas
What symptoms will someone with sarcoidosis classically present with?
Non productive cough Dyspnoea that gets worse as the disease progresses Fatigue Lymphadenopathy Pain in the knees, ankles and wrists Uveitis
Who is most likely to get sarcoidosis?
Bimodal age distribution so in 30s or 50s
Slightly higher prevalence in black people
What are the first line investigations for sarcoidosis? What would you susepct to see?
ESR- raised
CRP- raised
Chest x ray- lymphadenopathy etc
Serum urea- raised if theres renal involvement
Serum creatinine- raised if theres renal involvement
LFTs- AST and ALT raised if theres liver involvement
Serum calcium- hypercalcaemia
ECG- to rule out cardiac involvement
What electrolyte balance is common in sarcoidosis and why?
Hypercalcaemia, macrophages and lymphocytes make calcitriol unregulated
What is the first line treatment for sarcoidosis
If symptoms are mild eg stage 1/2 or early stage 3 none is needed
Otherwise first line oral corticosteroids
What organ does sarcoidosis affect?
Most commonly the lung but it can affect any organ
How many stages to sarcoidosis are there and what are they briefly?
There are 4 stages (I-IV):
I- lymphadenopathy of the hilar nodes in the lung
II- lymphadenopathy and parenchymal (functional lung tissue) disease
III- parenchymal disease alone
IV- fibrosis
What is gout?
An acute inflammatory reaction to the deposition of urate crystals in a joint
What joint is most likely to be affected by gout?
The big toe
What symptoms will someone with gout classically present with?
Acute joint pain Severe pain (often the worst they have ever felt) Swelling Tenderness Tophi
Who is more likely to get gout?
Older people
Male sex
Those on certain drugs as aspirin, cyclosporin,
Those who consume meat, alcohol etc
What drugs might predispose someone to gout?
Aspirin
Cyclosporin
What is the first line investigation for gout? What will you expect to see
Arthrocentesis- you will see raised white cells (primarily neutrophils), needle shaped crystals and negative birifringence
What shaped crystals and birifringence will you see on arthrocentesis in gout?
Needle shaped crystals with negative birifringence
How is gout managed?
First line NSAIDs, colchicine and corticosteroids
If recurrent use allopurinol to reduce urate levels
What is pseudogout?
An inflammatory arthropathy due to the deposition of calcium pyrophosphate crystals
What type of crystals are deposited in pseudogout?
Calcium pyrophosphate
What are the 2 types of pseudogout and how do they differ?
Acute
Chronic- this mimics osteoarthritis