Musc Flashcards
What happens physiologically in osteoarthritis
Imbalance in chondrocytes breaking down and producing cartilage due to excess stress such as obesity. Breakdown of articular cartilage leads to inflammation which triggers nerves
Risk factors for osteoarthritis
High age Associated inflammatory conditions like rheum and SLE Joint injuries Obesity Strenuous sports
Signs of osteoarthritis on examinations of hands
PIP- bouchards nodes
DIP- heberden nodes
Swollen first MCP
Joints affected in osteoarthritis
Weight bearing- knees, ankles, hips, lumbar spine and wrists
Symtpoms of osteoarthritis
Stiffness in morning of less than an hour
Sharp ache in joints worse with activity
X ray findings of osteoarthritis
Loss of joint space
Osteophytes
Sunchondral sclerosis
Subchondral cysts
What is eburnation
Where cartilage is lost leading to bones rubbing together
Signs on examination of osteoarthritis joints
Crepitus
Osteophytes
Loss of motion
NO swelling
What is another name for reactive arthritis
Reiters syndrome
What is genetic association of reactive arthritis and what other conditions are associated with it
HLA-B27
Ankylosing Spondylitis
Psoriasis
UC
What is reactive arthritis an example of
Seronegative spondyloarthropathy
What joints are normally affected in reactive arthritis
Can be multiple or often just 1 affected- often the knee
What is only organism causing reactive arthritis that doesnt cause a sterile joint
Gonorrhoea
Common organisms associated with reactive arthritis
Shigella Campylobacter Chlamydia Gonorrhoea Salmonella Yersinia
Reiters triad
Conjunctivits- painful red eye
Urethritis- pain when urinating
Arthritis
Signs of reactive arthritis on examination
Keratoderma blenorrhagicum
Circinate balanitis
Mouth ulcers
Other organs that can be affected in reiters syndrome but less commonly
Cervix
Pericarditis
What is triad of feltys syndrome
Neutropenia
Splenomegaly
Associated with RA
When is osteoarthritis pain worse
Evening
How can osteoarthritis be classified
Generalised
Localised-often nodal
Which joint is most commonly affected in nodal osteoarthritis
DIP
What joints other than DIP and PIP are affected in nodal osteoarthrits
First carpometacarpal joint
What happens to first carpometacarpal joint in osteoarthrits
Bony swelling leading to square appearance of hand
When is polymyalgia rheumatica pain worse
Morning
Rheumatoid x ray findings
Reduced joint space Soft tissue swelling Periarticular osteopenia Bony erosions Subluxation Deformity of joint
Most common spetic arthritis cause
S aureus
Common septic arthritis cause in young people
Gonococcus
Main investigations for septic arthritis
Aspiration and blood cultures
Then think about X ray
What in joints can reactive arthritis also affect
Entheses
Common ethesitis of reactive arthritis
Achilles tendonitis
Plantar fasciitis
Note aslo get dactylitis
Non joint symptom of ankylosing spondylitis
Conjunctivitis
Which joint does nodal OA affect most commonly
DIP
Then first MCP
What is seen in legs in OA
Varus or valgus deformation
What are crystals in gout
Uric acid
Physiology of uric acid
Comes from purine metabolism
Should be excreted by kidneys
What joint is most commonly affected in gout
1st MTP
Birefringe result of gout and pseudogout
Gout- negative
Pseudogout- positive
Blood test findings of gout
Raised CRP and ESR
Raised urate
Who does pseudogout occur in
Elderly
Which joints does pseudogout occur in
Knees and wrists
How does pseudogout present
Acute onset wrist or knee pain
Swelling
How does gout appear on X ray
Peri-articular erosion
Examination of gout
Swelling
Tophi present
What are soft tissue deposits of gout called
Tophi
Systemic complications of RA
Pericarditis Vasculitis Episcleritis Keratitis ILD RF nodules Felty syndrome Raynauds
What eases RA symptoms
Exercise
Joint pain that eases with exercise
RA
Is RA symmetrical or asymmetrical
Symmetrical
Joint pain in PMR
Stiffness in neck, spine, shoulders and hips
What is only sign on X ray you see of RA early on
Soft tissue swellin
In RA which hand joint is often spared early
DIP
How can you get carpal tunnel syndrome in RA
Inflammation of flexor tendon sheath
Signs on examination of RA
Boutonniere
Swan neck
Ulnar deformity
Carap tunnel syndrome
What percentage of psoriatic patients get arthritis
5-10%
Which joint does psoriatic arthritis tend to affect
Most commonly asymmetrical DIP
What is a good indicator psoriasis patient will get arthritis
Onochylysis
What is main risk of psoriatic arthrits
Arthritis mutilans where osteolysis occurs shortening the finger
How does dermatomyositosis present
Proximal limb weakness with skin changes too
What are crystals in gout
Monosodium urate
Risk factors for gout
High protein- red meat
Alcohol
Kidney dysfunction
Where are rheumatoid nodules found
Pressure points like the elbows
What do rheumatoid nodules feel like
Very firm
Why would you get recurrent infections in rheumatoid
Feltys syndrome
Associated conditions of seronegative spondyloarthropathies
Achilles tendonitis
Plantar fasciitis
Sacrolillitis
Presentation of ank spond
Back pain worse in morings
Stiffness in morning
Wake up latter half of the night
Later examination findings of ank spond
Abnormal schobers test
Abnormal wall to tragus test
Reduced chest expansion
Other features of ank spond
6as Anterior uveitis Aortitis Aortic regurg AV conduction block from fibrosis Apical lung fibrosis IgA nephropathy
Investigations for ank spond
Raised ESR and CRP
RF and Accp negative
X ray- sacroilitis
MRI- enthesitis, sacroilitis
What is bamboo spine seen in
Ank spond
Why are MRIs better than x ray in ank spond
MRIs pick up pathology earlier
5 joint psoriasis presentations
Symmetrical DIP and PIP arthritis Asymmetrical oligoarthritis- dactylitis DIP arthritis Arthritis mutilans Ank spond
Inflammatory symmetrical DIP and PIP ddx
RA
Psoriatic
Knee monoarthritis ddx
Crystal
Septic
Reactive arthritis
Investigations for reactive arthritis
Urethral/cervical swab for gonorrhoea
PCR- chlamydia
Stool sample if dysentery
Joint aspiration to exclude gout and septic arthritis
Is swelling normally seen in OA
No
Most common cause of hip pain in elderly
OA
Most common organ leading to clubbing
Lung
What chemical exposure is well known cause of clubbing
Asbestos
Cause of unilateral swollen leg
DVT Cellulitis Ruptured bakers cyst Muscular sprain Septic arthritis Allergic response to insect bite Compartment syndrome
Causes of bilateral swollen legs
Right heart failure Lymphoedema Venous insufficiency Pregnancy Vasodilators Hypoalbuminaemia Pelvic tumour compressing the IVC Fluid overload iatrogenic
What could cause vessel injury in virchows triad in leg
Trauma
Surgery
What would cuts and insect bites suggest about leg swelling
Insect bite- cellulitis, allergy
Cuts- cellulitis
Swelling getting bigger in unilateral leg swelling suggests what
Cellulitis
What does abdo pain and vaginal bleeding suggest about leg swelling
Ovarian mass compressing IVC
What does flaws suggest about unilateral leg swelling
Pelvic mass
What does recent surgery or radiotherapy to leg or abdo suggest about unilateral leg swelling
Lymphoedema
What does joint pain on movement suggest about unilateral leg swelling
Spetic arthritis
What are looking for in inspection of the leg in unilateral swelling
Cuts, punctures or insect bites- cellulitis or inflammatory response to bites Location of swelling Size Lymphadenopathy Abdominal masses Neurovascular status Pain on movement Febrile?
Why is location of swelling significant in unilateral leg swelling
Septic arthritis would be over a joint
Bakers cyst would come out of popliteal fossa and extend downwards
Compartment syndrome would be a whole muscle group
What would groin lymphadenopathy in unilateral leg swelling suggest
Infection of leg
Why is neurovascular status of limb important in unilateral leg swelling
Could be compartment syndrome
Investigations for DVT
Doppler US of leg
D-dimer
FBC- polycythaemia can cause it
Clotting study- thrombophillia
Management of DVT
Anticoagulation
Copression stockings
Lifestyle advice
How can ruptured bakers cyst be diagnosed
US
What is Volkmanns contracture
Irreversible atrophy of the limb
Management of cellulitis
Take FBC looking for neutrophillia
Flucloxacillin covering strep and staph
Demarcate progression using pen
Elevate leg
How to manage mosquito bite leg swelling
Topical steroids
Antihistamines
Management of bakers cyst
Elevation of limb
Aspirate fluid
Injection of corticosteroids into joint
What is chondrocalcinosis
Deposition of calcium pyrophosphate crystals
What arthritis is chondrocalcinosis seen in
OA
Main diagnostic marker of PMR
ESR over 40
