Musculoskeletal

Question 1

What is Osteoarthritis?

Answer 1

Osteoarthritis is a degenerative joint disease that is characterized by the breakdown and loss of cartilage in the joints.

Common condition that typically affects weight-bearing joints such as the knee, hip, and spine.

Question 2

What is Osteoarthritis characterised by?

Answer 2

• Progressive cartilage loss
• Joint space narrowing
• Development of osteophytes

Can lead to pain, stiffness and limited mobility

Question 3

H&E of Osteoarthritis

Answer 3

• Gradual onset in middle aged/older people
• Knee, hip, hand or spine involvement
• Pain on use/weight bearing
• Stiffness
• Swelling
• Physical examination may reveal joint tenderness, crepitus, bony enlargements or deformities + reduced joint space

Question 4

What deformities are seen in Osteoarthritis?

Answer 4

• Heberden’s nodes (DIP)
• Bouchard’s nodes (PIP)
• Squaring at the base of thumb
• Varus/Valgus at knee

Question 5

Investigations for Osteoarthritis

Answer 5

• X-ray
  
  • Loss of joint space
  • Subchondral sclerosis
  • Cysts
  • Osteophytes
• Bloods and inflammatory markers - normal
• MRI or US may be used to visualise joint structures and can be useful is making early diagnosis

Question 6

Management of Osteoarthritis

Answer 6

• Self-management
• Education about avoiding activities that exacerbate joint pain, and maintain healthy lifestyle
• Paracetamol and topical NSAIDs (NSAIDs only for hand or knee) - First-line
• Second-line is oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream or intra-articular corticosteroids
• non-pharmacological treatment options include supports and braces, TENS and shock-absorbing insoles or shoes
• Physiotherapy/hand therapy/podiatry/occupational therapy
• if conservative methods fail then refer for consideration of joint replacement

Question 7

What are the causes of Osteoarthritis?

Answer 7

• Ageing
• Obesity or being overweight
• History of injury or surgery to a joint
• Joint overuse
• Joints that do not form correctly
• FHx of Osteoarthritis

Question 8

What is Osteomalacia?

Answer 8

Condition where bones become soft and weak due to a deficiency in vitamin D or calcium

Metabolic Bone disease which results in impaired mineralization of bone matrix

In children this is called rickets

Question 9

Causes of Osteomalacia

Answer 9

• Vit D deficiency
  
  • malabsorption
  • lack of sunlight
  • diet
• CKD
• Drug induced e.g. anticonvulsants
• Inherited (hypophosphatemic rickets)
• Liver disease e.g. cirrhosis
• Coeliac disease

Question 10

H&E for Osteomalacia

Answer 10

• Bone pain
• Muscle Weakness
• Difficulty walking or standing for extended periods of time
• Skeletal deformities
• Fractures (especially NOF)
• Physical examination may reveal tenderness over bones, muscle weakness and a waddling gait (due to proximal myopathy)

Question 11

Diagnosis of Osteomalacia

Answer 11

• Bloods : low serum Ca2+, low serum PO43-, raised ALP and PTH
• X-ray to looks for bone abnormalities
  
  • Looser’s zones - translucent bands
  • Increased radiolucency in bones
  • Bowing deformities
• Bone biopsy

Question 12

Management of Osteomalacia

Answer 12

• Vitamin D supplementation
• Calcium supplementation
• Sun exposure
• Dietary changes
• Avoid factors that may interfere with vitamin D metabolism such as certain medications (e.g. anticonvulsants) or excessive alcohol consumption.
• In severe cases, bisphosphonates or calcitriol may be used to improve bone density and reduce the risk of fractures.
• Physical therapy
• Regular monitoring of bone density and vitamin D levels is important to prevent further bone loss and complications.