Musculoskeletal Flashcards
What is osteoarthritis?
Non-inflammatory wear and tear of joints resulting from loss of cartilage
Describe the epidemiology of osteoarthritis
- Most common type of arthritis
- More common in females
- More common in elderly
What are 6 risk factors for osteoarthritis?
- Obesity
- Age
- Female
- Family history
- Trauma
- Occupations associated with manual labour
Describe the pathophysiology of osteoarthritis
- Imbalance between cartilage being worn down and the chondrocytes replacing it
- Usually occurs in larger, weight-bearing synovial joints e.g. hips and knees
What are 3 common symptoms of osteoarthritis?
- Joint pain exacerbated by exercise
- Joint stiffness after rest (transient in morning)
- Reduced functionality (limited joint movement)
What are 2 additional symptoms of osteoarthritis?
Bone swellings in fingers:
- Herberden’s node (in distal interphalangeal joints)
- Bouchard’s node (in proximal interphalangeal joints)
What is the investigation for patients with osteoarthritis and the 4 most common findings?
X ray (LOSS):
- L - loss of joint space
- O - osteophytes formation
- S - subchondral sclerosis (increased density of bone along joint)
- S - subchondral cysts (fluid-filled holes in bone)
What is the treatment for osteoarthritis?
- Pain relief (start with paracetamol and work up analgesics ladder)
- Cortisol injections
- Physiotherapy
- Weight loss
- Joint replacement (must lose weight)
What is the difference between pain in patients with osteoarthritis vs rheumatoid arthritis?
Osteoarthritis - worse during/after exercise
Rheumatoid arthritis - better during/after exercise
What is rheumatoid arthritis?
Autoimmune inflammation of synovial joints - symmetrical polyarthritis
Describe the epidemiology of rheumatoid arthritis
- More common in females (3:1)
- Most often develops younger/middle age
What are 4 risk factors for rheumatoid arthritis?
- Genetics - HLA DR4 gene (often present in RF positive patients)
- Genetics - HLA DR1 (often present in RA patients)
- Rheumatoid factor (RF)
- Cyclic citrullinated peptide antibodies (anti-CCP)
What does rheumatoid factor (RF) do?
Autoantibody that targets Fc portion of IgG antibody, triggering activation of the immune system
Describe the pathophysiology of rheumatoid arthritis
- Autoimmune destruction of synovium
- Inflammation causes damage to bone cartilage, tendons and ligaments
- Most common joints affected are PIP joints and MCP joints (HARDLY EVER DIP JOINTS - if these are affected, it is usually always osteoarthritis)
What are 5 signs of rheumatoid arthritis?
- ‘Boggy’ feeling when palpating synovium around joints
- Z-shaped deformity of thumb
- Swan neck deformity (hyperextended PIP with flexed DIP)
- Boutonnieres deformity (hyperextended DIP with flexed PIP)
- Ulnar deviation of fingers at knuckle
What are 5 symptoms of rheumatoid arthritis?
- Joint pain/swelling/stiffness (pain worse after rest/in the mornings and improves with activity)
- Fatigue
- Weight loss
- Flu-like illness
- Muscle aches/weakness
What is palindromic rheumatism?
- Self-limiting short episodes of inflammatory arthritis with joint pain/stiffness/swelling
- Lasts 1-2 days and then completely resolves itself
- May progress to full RA (greater risk if have RF and anti-CCP antibodies)
What are 2 investigations for patients with rheumatoid arthritis?
- X-ray
- Bloods
What does an x-ray show in patients with rheumatoid arthritis?
LOES:
- L - lost joint space
- O - osteopenia (reduced bone density)
- E - erosion
- S - soft tissue swelling
What do bloods show in patients with rheumatoid arthritis?
- Anti-CCP antibodies (more sensitive and specific than RF)
- RF
- Raised ESR/CRP
What is the treatment for rheumatoid arthritis?
- Physiotherapy
- Ibuprofen/NSAIDs
- Steroids
- Methotrexate
- Rituximab (if others not working)
What are 3 complications of rheumatoid arthritis?
- Atlantoaxial subluxation –> cervical spinal cord compression
- Inflammation of tendons increases risk of tendon rupture
- Lung involvement e.g. interstitial lung disease, fibrosis etc.
Describe atlantoaxial subluxation
- Local synovitis and damage to ligaments and bursa around odontoid peg of axis (C2) and atlas (C1)
- This causes the axis (C2) and odontoid peg to shift within the atlas (C1)
- Subluxation causes cervical spinal cord compression (weakness/loss of sensation) and is an EMERGENCY
What must be excluded when investigating patients with gout/pseudogout?
Septic arthritis (life threatening - medical emergency)