Musculoskeletal

Question 1

Rheumatology conditions managment:

Answer 1

1. Osteoarthritis: all patients should be offered help with weight loss, given advice about local muscle strengthening exercises and general aerobic fitness; 1st line medication: topical NSAID; 2nd line: oral NSAID with PPI; 3rd line: intra-articular steroid
2. Rheumatoid arthritis: DMARD +/- short course of bridging corticosteroid
3. Psoriatic arthritis: NSAIDs/physio +/- DMARD
4. Ankylosing spondylitis: NSAIDs/physio +/- DMARD
5. Reactive arthritis: NSAIDs/intra-articular steroid OR oral ABx +/- DMARD
6. Enteropathic arthritis: treat the cause (use NSAIDs with caution)
7. Gout: NSAIDs OR colchicine. If both contraindicated then prednisolone 15mg/day; allopurinol
8. Pseudogout: NSAIDs are the mainstay of treatment; joint aspiration and intra-articular corticosteroids are of benefit in acute flares of pseudogout
9. Polymyositis: prednisolone 40–60 mg daily
10. Dermatomyositis: prednisolone 40–60 mg/day
11. Giant cell arteritis: prednisolone 40–60 mg/day
12. Polymyalgia rheumatica: prednisolone 15 mg/day initially; ↓dose slowly, e.g. by 1mg/month (according to symptoms/ ESR)
13. Septic arthritis: flucloxacillin for 4-6 weeks (IVOST at 2 weeks)
14. Osteomyelitis: flucloxacillin for 6 weeks

Question 2

Metabolic bone condition summary

Answer 2

General rules:
1. Osteoporosis and osteopetrosis are all normal
2. Paget’s causes an isolated rise in ↑↑ALP
3. Osteomalacia will cause a decrease in ↓calcium and ↓phosphate (while increasing ↑ALP aand ↑PTH)
4. Primary hyperparathyroidsim: isolated decrease in ↓phosphate while everythiing else ↑; CKD isolated decrease in ↓calcium while everythiing else ↑

Question 3

Parathyroid bloods summary: