MSK Pathologies (not joint specific) Flashcards
What are some examples of rheumatic diseases?
- Rheumatoid arthritis
- Osteoarthritis
- Axial spondyloarthritis (e.g. ankylosing spondylitis)
- Gout
- Psoriatic arthritis
What are rheumatological diseases be caused by?
- Problems in the immune system
- Inflammation
- Gradual deterioration joints, muscles and bones
What are indicators of rheumatological conditions?
- More than one joint affected
- Family history of RA or other rheumatological condition
- Early morning stiffness which lasts more than 30 minutes
- Fatigue
- Swollen joints
- Joints feel better after light activity
- Uveitis, psoriasis
What is the Axial Spondyloarthritis referreal criteria?
LBP starting before the age of 45, has lasted for longer than 3 months and 4 or more of the following are present:
- LBP started before the age of 35
-Waking during the second half of the night due to symptoms
- Buttock pain
- Improvement with movement
- Improvement within 48 hours of taking NSAID’s
- A first degree relative with spondyloarthritis
- Current or past arthritis
- Current or past enthesitis
- Current or past psoriasis
Who is osteoporosis more common in?
women
Osteoporosis.
reduced bone mineral density (BMD)
What are the most common sites for osteoporotic fractures?
- Spine
- Wrist
- Hip
- Pelvis
What are risk factors for osteoporosis?
- Female
- Over 50
- Low body weight
- Previous fracture or height loss
- Smoking
- High intake of alcohol
- Amenorrhea
- Early menopause (before 45)
- Inflammatory conditions (e.g. RA, Crohn’s)
- Conditions affecting hormone producing glands
- Family history of osteoporosis
- Long term use of medications which affect bone strength e.g. prednisolone
- Poor diet lacking calcium, vitamin D, fruit and vegetables
- Too much protein, sodium and caffeine
- Malabsorption problems
- Vitamin D deficiency
- Inactive lifestyle
How can septic arthritis develop?
When an infection (such as a skin infection or urinary tract infection) spreads through your bloodstream to a joint
Less commonly:
- puncture wound
- drug injection
- surgery in or near a joint (including joint replacement surgery) - can give germs entry into the joint space
What is osteomylitis?
an infection in a bone (can affect more than 1 part of a bone)
How can osteomylitis occur in bone?
- Infections can reach a bone through the bloodstream or from nearby infected tissue.
- Infections also can begin in the bone if an injury opens the bone to germs.
What joints are commonly affected by septic arthritis?
- Knee
- Wrist
- Ankle
- Hips
- Symphysis pubis
What are signs & symptoms (S&S) of septic arthritis?
- Painful, red swollen joint
- Reduced range of motion
- Systematically unwell & fever
What are risk factors of septic arthritis?
- Inflammatory joint
- Disease
- Diabetes
- IV drug use
- Alcoholism
- Immunosuppression
- Malignancy
- Recent trauma or surgery
What must be done if patient has septic arthritis?
prompt medical intervention is needed to treat and prevent joint damage
Where and who is osteomylitis most common?
Children - the growing ends of long bones
Adults - the spine
What is a signs & symptom (S&S) of osteomylitis?
present with fever & pain at the infection site
How can osteomylitis be treated?
- Antibiotics
- Surgical drainage (infection of fixation devices can occur)
What are signs & symptoms (S&S) to look out for spinal infections (Vertebral osteomylelitis, Discitis, Epidural abscess)?
- Fever; systemically unwell.
- Recent infection.
- Diabetes mellitus.
- History of intravenous drug use.
- HIV infection (use of immunosuppressant drugs, or other cause of immunocompromise)
What are the abdominal organs/anatomy that can refer to lower back/quadrant?
- Kidney
- Bladder
- Bowel
- Ovaries
- Uterus
- Prostate
- Abdominal aorta
- Hernias
Which types of cancer have a higher chance of metastasising to bone?
- Breast
- Prostate
- Lung
- Kidney
- Thyroid
What are medications which can masquerade as an MSK problem?
- Glucocorticoids
- Steroids
- Statins
- Beta-blockers
- Hormones
- Diuretics
Axial Spondyloarthritis (axSpA)
= a long-term inflammatory arthritis affect the spine and other joints, tendons and ligaments
What are the (8) symptoms of Axial spondyloarthritis (axSpA)?
- Low back pain (that starts before the age of 35-45 years and has lasted at least 3 months)
- Associated night pain
- Buttock pain
- Symptoms that improve when you move around
- Symptoms that improve with non-steroidal anti-inflammatory drugs (NSAIDs) - e.g, ibuprofen and aspirin
- A close relative with spondyloarthritis
- Associated with other type of arthritis (e.g., psoriasis)
- Pain or swelling in the joints not caused by an injury
What is Rheumatoid arthritis?
- affects body’s immune system by attacking cells that line the joint and causes them to become inflamed
- can limit motion and lead to damage of the joints, cartilage and nearby bone
What are the risk factors for Rheumatoid arthritis?
- genetic
- more prevalent in people over 65 year olds (most likely develop between 30-50)
- women are 3x more likely than men to be affected
- smoking
- infection or trauma
How does Rheumatoid arthritis affect patients?
- Worry about becoming progressively disabled
- Stop working sooner than expected (financial impact)
- Be less independent
- Experience changes in relationships
- Worry about having additional children if diagnosed young
- Feel isolated
- Become depressed
What is Osteoarthritis?
- degenerative joint disease in which tissues in the joints (i.e, cartilage, tendons, ligaments, synovium, bone) break down over time
- small bone growths (called osteophytes or bone spurs) may grow on edges of the joint
What fraction of Rheumatoid arthritis patients have major depression?
1/6
What fraction of Osteoarthritis patients report depression symptoms when the pain is the worst?
2/3
What is Rheumatology?
covers wide range of conditions affecting the musculoskeletal system
What are some examples of rheumatic diseases?
- Microscopic polyangitis
- Henoch-Schonlein Purpura
- Systemic lupus erythematosus
- Familial fever syndromes
- Scleroderma
- Polymyositis
- Dermatomyositis
- Acute rheumatic fever
- Lyme disease
- Rheumatic consequences of HIV infection
- Polymyalgia rheumatica
- Giant cell arteritis
- Polyarteritis
- Takayasu arteritis
- Granulomatosis with polyangitis
- Sjogren syndrome
- Fibromyalgia
- Gout
- Pseudogout
- Osteoarthritis
- Rheumatoid Arthritis
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis
- Post-infection arthritis
- Eosinophilic granulomatosis with polyangitis
- Behcet syndrome
- Cryoglobulinaemic vasculitis
Systemic Lupus Erythematosus (SLE)
a chronic autoimmune disease that can lead to inflammation and tissue damage in many parts of the body - skin, joints, heart, lungs, kidneys and brain
What are (11) common symptoms of Systemic Lupus Erythematosus (SLE)?
- Arthritis – affecting two or more joints, causing stiffness and pain
- Extreme fatigue and weakness
- Malar (butterfly) rash over the cheeks – often photosensitive
- Oral/nasal ulcers
- Hair loss
- Flu-like symptoms and/or night sweats
- Inflammation of the tissues covering the internal organs (serositis) with associated chest and/or abdominal pain
- Haematological disorders including anaemia
- Kidney problems, often first seen as proteinuria
- Seizures, mental illness or other cerebral problems
- Headaches, migraine
What are the (10) symptoms of Ehlers-Danlos Syndrome (most commonly Hypermobile EDS)?
- Focal and generalised joint pain (including dislocations)
- Muscle spasms, muscle weakness, ‘restless legs’
- Fatigue
- Poor sleep
- Anxiety
- Gastrointestinal disorders (e.g. IBS, reflux, disordered gut motility)
- Fragile/stretchy skin, poor wound healing, hernias, easy bruising
- Headaches, brain fog, poor memory, poor concentration
- Palpitations
- Bladder/pelvic floor problems
What causes gout?
- sedentary lifestyle and obesity
- harmful products
- kidneys don’t excrete uric acid (this builds u in joints and crystalises)
What treatment is there for gout?
- anti-inflammatory drugs
- painkillers
What are the symptoms of gout?
- inflammation
- redness
- temperature
- aching joints
- severe pain (especially at night)
What are the (10) symptoms of Giant Cell Arteritis?
- Headaches (sudden or gradual mainly at the temples)
- Tenderness of the scalp area over the temples
- Blood vessels at the temples may look or feel prominent
- Pain in the jaw or tongue when chewing or talking
- Blurred or double vision or temporary sudden loss of vision
- Fatigue
- Depression
- Night sweats
- Fever
- Loss of appetite and/or weights loss
What is Giant Cell Arteritis?
immune cells gather at the site of the attack and form giant cells damaging arterial walls and causing inflammation
What are the (10) symptoms of Polymyalgia Rheumatic?
- Inflammation of tissues around the joints
- Stiffness, pain, and tenderness in the neck, shoulders, pelvis, and hip muscles.
- Worse early in the morning but easing during the day
- Difficulty getting out of bed, reaching and rising
- Inflammation and swelling in other areas (i.e. tendons, hands, feet, and joints)
- Fatigue
- Depression
- Night sweats
- Fever
- Loss of appetite and/or weight loss
What are (8) common symptoms of the hypermobile Ehlers-Danlos Syndrome (hEDS)?
- Focal and generalised joint pain, including dislocations
- Muscle spasms, muscle weakness, ‘restless legs’
- Fatigue, poor sleep, anxiety
- Gastrointestinal disorders (e.g. IBS, reflux, disordered gut motility)
- Fragile/stretchy skin, poor wound healing, hernias, easy bruising
- Headaches, brain fog, poor memory, poor concentration
- Palpitations
- Bladder/pelvic floor problems
What is Gout (& what can it cause)?
- Urate crystals form in and around the joints and under the skin as small white pimples (tophil).
- Inflammation can cause skin to peel
- Skin is red and shiny
- Mild fever, loss of appetite, tired
- Kidney stones (occasionally)
Giant Cell Arteritis
An autoimmune response where immune cells gather at the site of attack and form giant cells damaging arterial walls and causing inflammation
- Headaches
- Tenderness of scalp
- Prominent blood vessels on the temples
- Jaw or tongue pain when chewing or talking
- Blurred or double vision or temporary sudden loss of vision
- Fatigue
- Depression
- Night sweats
- Fever
- Loss of appetite and/or weight loss
Polymyalgia Rheumatica
autoimmune disease involving inflammation of tissues around the joints
- Stiffness, pain and tenderness in the neck, shoulder, pelvis and hip muscles
- Worse early in morning, eases during the day
- Difficulty getting out of bed, reaching and rising
- Inflammation and swelling in other areas
- Fatigue
- Depression
- Night sweats
- Fever
- Loss of appetite and/or weight loss
When do acute attacks of gout develop?
the night or early morning (and reach their peak in a few hours)
What can happen if gout attacks are left untreated?
attacks can become more frequent and prolonged
What is Sclerosis?
increased bone density (seen as whiter areas on the x-ray)
