MSK conditions Flashcards
SLE Cause, triggers, who? Diagnosis Symptoms: mild/mod/severe, characteristic Treatment
Systemic Lupus Erythematosus
Autoimmune, mainly affects pre-menopausal women. Associated with HLA. Triggers: viral infection, strong meds, UV light, puberty, childbirth, the menopause.
Diagnosis often complex due to systemic features which overlap.
ANA is not specific but sensitive (ie most people with lupus have it, but having it does not necessarily mean lupus). anti dsDNA specific but not sensitive.
FBC may show anaemia of chronic disease, thrombocytopenia, neutropenia
Raised ESR, normal CRP.
Symptoms:
Butterfly rash -‘malar’, joint pain and stiffness, extreme fatigue. (+/- weight loss, Raynaud’s, photosensitive rash, swollen glands, mouth ulcers).
Systemic involvement - lungs (effusions, pneumonitis) heart (pericarditis, effusions, IHD, arrythmias), kidneys (glomerulonephritis, persistent proteinuria), CNS (depression, seizures, psychosis), eyes (conjunctivitis, Sjogren’s).
TREAT:
immunosuppresives
acute = IV cyclophosphamide + high dose prednisolone
severe = oral aziathioprine/methotrexate + high dose prednisolone, rituximad biologic.
Anti-malarials (such as hydroxychloroquine) and NSAIDs used.
Ankylosing spondylitis Cause, who, what, triggers Diagnosis Symptoms treatment
Inflammation of the spine leads to errosion, formation of syndesmophytes which fuse the spine.
Men > women, teens/young adults. Family history. Environment: klebsiella, shigella, salmonella. Link with HLA-B27.
Diagnosie: ERS/CRP, imaging of spine showings sacroliitis + symptoms = definitive, otherwise ‘probable AS’
Symptoms:
Back pain - worse in morn and at night, woken up by pain. Bum pain radiates to knee (not sciatica). Limited movement lumbar spine/limited chest expansion. Other arthritis may be present as well as enthesitis or shin/achilles/ribs to breast bone. Fatigue.
Treat:
Not curable
- physio and exercise
- NSAIDs
- start anti-TNF inflixumab early to prevent syndesmophytes
- directly injected corticosteroids for short term relief
what are spondylarthropathies?
seronegative (Rf) inflammatory diseases of the joints and entheses
AS, psoriatic arthritis, reactive arthritis, enteropathic spondylarthritis
Psoriatic arthritis: what? diagnose symptoms treatment
Progressive flare ups and remission, joint inflammation that usually develops in individuals with psoriasis. 50% HLA-B27 positive. 1/2 in every 5 with psoriasis develop it.
Diagnosis = XR joints. ESR and CRP often normal.
Symptoms: DIPJs most commonly affected, hands feet knees neck spine elbows. Psoriatic rash - may be hidden beneath fingernails/in umbilicus! STiff, painful, swollen inflamed joints.
Treat: NSAIDs, corticosteroids. DMARDS: leflunomide, methotrexate. Immunosuppressive: methotrexate/ciclosporin.
If meth. fails biologics - infliximab/golinumab.
Reactive arthritis What/who Diagnose symptoms treatment
Sterile inflammation of synovial membrane triggered by infection at a different site. Men 20-40, secondary to infection usually STD/GI. Link with HLA-B27.
Diagnosis based on hist. infection and ruling out differentials, synovial fluid sterile.
Hot swollen stiff, usually affects lower limbs. Dysuria/discharge/ulceration of genitals. Pain/redness/conjunctivitis of eyes. Can’t see, can’t wee, can’t climb a tree…
Treat: antibiotics for infection. NSAIDs/analgesia. Usually clears up, if develops into relapsing use methotrexate.
Septic arthritis what/who Cause Symptoms Diagnosis - differential? Treatment
Acutely inflamed infected joint, a medical emergency.
Who: immunosuppressed, pre-existing joint disease eg RA, diabetes, prostehtic joint/recent surgery, intra-articular steroid injection, direct/penetrating trauma
Caused by: s. aureus (most), streptococci, neisseria gonorrhoea, H. influenzae (children - rare due to vaccine), gram-ve: e.coli, p.aeruginosa (elderly, very young, IVDU).
Very painful hot red swollen joint. 50% knee.
Diagnose:
Joint aspiration IMMEDIATELY, before antibiotics. Send for culture. Pussy/purulent fluid. Exclude gout by doing light microscopy to look for crystals.
Raised ESR and WCC, CRP may be normal.
Treat:
stop methotrexate and anti-tnf if already on, double prednisolone if already on - as these individuals will not be producing their own cortisol!
IV flucloxacillin
Rheumatoid arthritis what, who? cause? signs and symptoms diagnosis treatment
Autoimmune, chronic inflammatory disorder. Inflammation in joints leads to formation of a pannus: thick, swollen synovial membrane with granulation tissue. Damages cartilage, erodes bone.
Unknown cause. F>M. Link with HLLA-DR4 and HLA-DRB1 genes.
Signs: boutonniere, swan neck, ulnar deviation. Symmetrical peripheral polyarthritis, mainly affects MCP and PIPs, plus wrists, shoulders, elbows, knees, ankles. Joints stiff warm and painful, esp. morning >30mins. Worse on periods of inactivity. Systemic symptoms. Extra-articular involvement.
Diagnose: raised CRP and ESR. Normocytic anaemia. Rf +ve in 80%, anti-ccp in 30%, presents earlier and with worse prognosis. XR, USS, MRI. Joint aspirate if effusion.
Treat:
No cure. Lifestyle.
Analgesia - NSAIDs
DMARDs - sulfasalazine for mild/mod, methotrexate for severe.
Biologics: above + tnf alpha blocker infliximab.
Osteoarthritis what? who? risk factors? signs symptoms diagnosis treat
Protective cartilage breaks down, exposing underlying bone to increased stress. Bone becomes sclerotic and overgrows at joing margins. Cartilage ulceration + disordered bone repair.
F>M, post menopausal. Age, genetics, obesity (=pro-inflammatory state), manual occupation, other inflammatory arthritis (RA).
Heberden’s nodes at DIPJs, Bouchard’s nodes at PIPJs. Weight-bearing joints: knee, hip, vertebrae. 1st metatarsophalangeal joint.
Joint pain worse with movement, stiffness after rest, transient morning stiffness < 30mins. Not ass. with systemic symptoms.
Diagnose:
Mainly based on history, ruling out differentials.
elevated CRP, negative Rf and ANA (exclude differentials).
Imaging
Aspiration of synovial fluid reveals painful viscous effusion with few leukocytes.
Treat:
Lifestyle: weight loss, exercise, physio
Analgesia, paracetamol before NSAIDs
Corticosteroid injection for short term relief (not before surgery - immunosuppressive)
Surgery: arthroscopy to remove loose bodies, arthroplasty replacement
Gout what? where Risk factors symptoms diagnose treat
Uric acid usually excreted by kidneys, if high levels can form urate -> crystals. Inflammation occurs in attempt to clear.
Usually affects 1st metatarsal. Also knee, ankle, wrist, elbow.
M>f, diet: shellfish, red meats and fish, sat fats, alcohol, obesity, diabetes, CKD, thiazide diuretics/aspirin, fizzy drinks, genetics, chemo&radiation
Symptoms
Attacks of sudden severe pain - ‘on fire’. Woken up by pain, even bedsheets irritate.
Diagnose:
Joint fluid aspiration: polarised light microscopy shows negatively bifringent crystals
Raised serum uric acid (although falls after acute attack)
Monitor for renal impairment
Treat:
NSAIDs
Intraarticular corticosteroid injection - painful but effective
Treat underlying cause, lifestyle mod
Allopurinol decreases uric acid prod.
Pseudogout what? commonly affects which joints? risk factors diagnose treat
deposition of calcium pyrophosphate crystals on joint surface. Knee, wrist.
elderly, old age, diabetes, OA, trauma, metabolic disease (hyperparathyroidism, haemachromatosis)
Joint aspiration shows positively bifringent crystals under polarised light microscopy. Culture purulent fluid to exclude septic arthritis!
Treat
nsaids, inject prednisolone, apiration reduces pain
