MSS Case 1: Osteoarthritis Flashcards
Describe the anatomy and function of lower limb bones, joints and muscles
See lecture
Meniscus: Accommodate changes in the shape of articular surfaces during joint movements
Describe the functional anatomy of foot, lower limb and gait
Normal gait —> minimise amount of energy needed to maintain locomotion and produce a smooth, efficient gait
- Pelvic tilt / drop in coronal plane of swing side (abduction on contralateral side to limit the drop)
- Pelvic rotation in transverse plane
- Knee flexion
- Ankle and knee motion
- Lateral displacement of pelvis
Keep body’s centre of gravity within 5cm deviation vertically / laterally
Discuss how gait may be affected by abnormal function of lower limb bones, joints, muscles
Limping gait —> due to pathology of MSS system of affected lower limb
Causes:
- Bone disease
- Muscle disease
- Joint disease
- Periarticular disease
Describe the pathology of common inflammatory and degenerative arthritis affecting the lower limbs
Inflammatory arthritis
- Inflammatory autoimmune disease
- Systemic, Chronic
- Affect extraarticular structures as well
- Nonsuppurative proliferative synovitis
- **Pannus, **Ankylosis, ***Stiffening of joint
Degenerative arthritis
- Degeneration of articular cartilage
- Breakdown of matrix in response to biomechanical stress
- ***Narrowing of joint space, Subchondral sclerosis, Subchondral cyst, Osteophyte
Primary osteoarthritis
- with age / without apparent initiating cause
Secondary osteoarthritis
- youth onset
- predisposing condition e.g. trauma, developmental deformity, obesity
Discuss MOA of commonly used analgesic and anti-inflammatory drugs
See lecture
- Paracetamol
- NSAIDs
- Corticosteroids
- inhibit COX-2 synthesis
- produce Lipocortin which inhibit Phospholipase A2
- inhibit synthesis of Pro-inflammatory cytokines
Discuss use of anti-inflammatory drugs in treatment of chronic arthritis
Initial treatment
- Paracetamol
If Paracetamol inadequate / inflammatory OA
- + NSAIDs
If NSAIDs and paracetamol insufficient
- Intraarticular glucocorticoids
Discuss need of a multidisciplinary approach in management of chronic arthritis and other disabling disorders
- Doctor: Pharmacological therapy —> Pain relief
- Nutritionist: Weight loss, Exercise plan
- Physiotherapy: Relieve pain, Restore joint function
- Occupational therapist: Joint protection methods and devices such as splints
- Medical social workers: Provide help on socio-economic aspect
Others:
- Nurse case managers:
- mange patients by protocol
- add clinical and self-management skills
- greater intensity of care - Medical specialist
- Clinical pharmacists
- optimise drug regimens to reduce adverse effects and increase efficacy - Medical social workers
- help acquire community resources
- integrate patients back into community - Lay health workers (e.g. community health workers / health aides)
- ease difficulties of caring for vulnerable populations
Advantages: Medical professionals: - improve clinical decision making - more coordinated patient care - improvement to overall quality of care - more evidence based treatment decisions
Patient’s perspective:
- improve patients’ satisfaction
- clinical and health status
- reduce use of heath services
Recognise signs and symptoms associated with inflammatory and degenerative arthritis
RA: - insidious onset - begins with systemic features —> joint inflammation + swelling + stiffness particularly in morning - ***enlarged joint - limited ROM
Degenerative:
- pain exacerbated by use of joint
- morning stiffness
- ***Pain relieved by rest —> respond to simple analgesics
- ***Crepitus
- limited ROM
Common investigations used in diagnosis of inflammatory and degenerative arthritis
- X-ray
- Cheap
- Define general nature
- Baseline for future reference
OA:
- Loss of joint space
- Subchondral sclerosis
- Subchondral cyst
- Osteophyte
RA:
- Loss of joint space
- Erosion of bones by Pannus
- Soft tissue swelling (joint effusion + edema + tenosynovitis)
- Osteopenia
- CBC
- ***exclusion of inflammatory arthritis
- Leukocytosis + Thrombocytosis —> Inflammatory arthritis
- Normochromatic, Normocytic anaemia —> RA - ESR
- ***exclusion of inflammatory arthritis
- Detect how fast RBC clump together on standing —> measure inflammatory response
- Increased in most inflammatory conditions and malignancy
- Normal value:
Men = Age / 2
Women = (Age+10) / 2
Recognise psychological and socio-economic impacts of chronic disorders on the patient
Recognise psychological and socio-economic impacts of chronic disabling disorders on the community
- Manage medical regimens
- Manage medical crisis
- Biographical disruption
- Family and Social life disruption
- Uncertainty (Pre-diagnostic + Trajectory + Symptomatic)
- Costs (Health care services + loss of work)
Recognise the need to counsel patients and relatives of chronic arthritis and other chronic disabling disorders
LO omitted
Describe the epidemiology of common chronic arthritis in HK
Prevalence of OA:
- majority of people by 65
- 80% > 75 yo
- Knee OA more common in Chinese (very rare to have Hip OA)
Outline social needs of patients with chronic arthritis and other disabling disorders
Compensation from company:
- OA ***NOT a compensatable occupational disease in HK
Disability allowance: The condition must: - Persist for >= 6 months - Severely disabling —> total loss of function —> disabling mental condition —> profoundly deaf - ***OA cannot apply for disability allowance
Rehousing:
- Housing department will consider need of people with disability / chronic diseases
- take into account opinions of family members, physiotherapist / occupational therapists
Importance of doctor-patient rapport especially in management of chronic medical illnesses
- Better compliance
- Improve patients’ satisfaction —> Less doctor-shopping
- Better communication, Reduce misunderstanding
- Reduce malpractice litigation
