Musculoskeletal Flashcards
define arthritis
a group of conditions characterized by inflammatoy changes to varous joints of the bodyh
four types of arthritis
auto immune
osteo
gout
septic/infectious
two types of auto immunte arthritis
rheumatoid arthritis
lupus
what percent of the population has RA
what is the gender ratio
when do most people get RA
1%
female 3:1
80% between 35-64
HLA-DR4 is associated with what
is this correlated to incidence
RA
no, only 10-15 percent of twins with HLA-DR4 will have concordant RA
pathophy of RA
autoimmune response causes inflammation of the synovial membranes of multiple joints
trigger of RA
unknow, suspected infectious agent or smoking
what is the only behavioral risk factor of RA
smoking
four non-joint manifestations of RA
is there an effect on lifespan
anemia, pleura, eye, skin
life span is shortened, mechanism unknown
2/3 of RA patients will present with what
fatigue, malise, generalized weakness, vague joint complaints
when wil acute synovitis occur in RA
what is the delay between onset of RA and diagnosis
weeks to months after diagnosis
9 months
what is the hallmark symptom of RA
early morning stiffness lasting more than one hour
what joints are most commonly affected by RA
MP, PIP, knees
T/F periodic swelling of joints, with rednesss and pain are common with RA
true
pannus formation
inflammatory response to inflammation from RA causes destruction of cartilage and erosion of bone
ulnar deviation is typical of what type of arthritis
RA
what joints can be affected by RA
almost any joint except those of the thorax but including the neck
what is the prognosis of RA
what percent untreated people will have disability
what percent will have a work disability
it depends, there is a fluctuation of disease
80% will have disability within 12 years
50% will have work disability within 10 years
medications used in treatent of RA
NSAIDs
physical therapy
glucocorticoids
DMARDs
treatment strategy for RA
relieive pain with NSAIDs and physical therapy
prevent joint damage with disease modifying drugs
possibly repair damage
what has changed recently in RA treatment
DMARDs have allowed for early intervention with aggressive treatment, if patients can afford them
which type of arthritis is more common (and the most common cause of disability in the US)
Osteoarthritis
three risk factors for OA
age, joint loading/repetitive stress, obestity
what is the intial pathophysiology of OA
how does that progress
thickening followed by atrophy and damage to cartiliage which causes loss of cartilage and inflammation
the entire joint wil become involved and cause bone erosion
though wear and tear is involved, what drives the ongoing damage
chronic inflammation
OA symptoms
pain on use that is worse with activity and improved with rest
<15 of stiffness each morning
differentiating factor between RA and OA
OA effects the hips and spine, RA doesn’t, though it can effect many joints
OA treatment types
anti-inflammatory/analgesia
cartilage repair
surgical
reduce joint loading
three examples of antiinflammtory/analgesic treatment of OA
NSAID, joint injections, heat therapy
methods to stimulate cartiliage repair in OA
glucosamine/chondroitin, chondroctye transplantation
surgical repair of OA
joint replacement
three ways to limt joint trauma in OA
reduce joint loading, change types of exercise, strengthen muscles
what is injected into a joint for OA
local anesthetic, glucocortcoids, hyaluronic acid
how many joints does gout usually effect
one
what is the cause of gout
a disorder which causes an accumulation of uric acid from gout and protein metabolism
T/f all gout will havy hypernuricema
true, but not all hyperuricemia will have gout
what joint is most commonly effected by gout
the big toe
tophus
a nodular deposit of urate monohydrate crystals that cuases a foreign body reaction
renal involvement of gout
urate crystals can deposit in the glomeruli and cause renal failure
gout treatment strategies
reduce acid production through diet
reduce inflammation
enhaance excretion
diet management of gout
decrease protein
stop chemo
allopurinol
what medication is used to treat gout by reducing inflammation
colchicine
what treatment that works on gout won’t be very helpful in other cases of arthritis
colchicine will reduce pain only in gout, not OA and RA
how long does an acute gout flare last
do they recur?
when wil gout cause joint deformity
several days to weeks
yes, in months or years later
only in early onset or untreated goiut
what causes septic arthritits
bacteria infection of a joint from bloood or direct joint inoculation
three bacteria agents that will cause septic arthritis
gonorrhea, staph, strep, TB
when would a septicemia cause arthritis
a systemic infection, comonly in immuno suppressed patients or IV drug usres
when is direct inoculation a common cause of septic arthritis
complication of joint injection or post surgical
treatment of septic arthritis
intravenous abx
removal of hardware
what is the prognosis of septic arthritis
usually good unless there are major ortho complication like after joint replacement
four types of primary bone cancer
multiple myeloma
osteosarcoma
chondrosarcoma
ewing sarcoma
three types of secondary bone cancer
mets from lung, breaks, prostate
what is the most common type of primary bone cancer
multiple myeloma
what is more common, secondary or primary bone cancer
secondary
describe multiple myeloma in three bullets
most common form of bone cancer
comes from a single plasma cell
produces large amounts of antibodies
what is the most common symptom of multiple myeloma
bone pain in the back or ribs that is worse with movement and beter at rest
three consequences of bone marrow failure found in multiple myeloma
anemia
bacterial infection
increased bleeding
what is the radiographic hallmark of multiple myeloma
punch out lesions
how is mutiple myeloma diagnosed
Xray
anemia
high IgG or Ig components
bone marrow biopsy with plasma cell prolifferation
T/F multiple myeloma bones are prone to fracture
true
what is the treatment for multiple myeloma
aggressive chemo, possibly bone marrow transplant
what is the process of a bone marrow transplant
destroy bone marrow with radiation and chem
transplant hematogenous stem cells
what is the median survival time for multiple myeloma
three causes of death
4-6 up from 3 years
renal failure, infection, complications from chemo
what is the second most common primary bone cancer
is it common overall?
when does it most commonly strike
osteosarcoma
no
60% in the first two decades
three subtypes of osteosarcoma
osteoblastic
fibroblastic
chondroblastic
where does osteosarcoma start
what is the msot common complaint
what is the risk of untreated cancer
in a long bone
bone pain with pathologic fracture
mets to other bones or the lungs
specific radiograhpic findings on xray
sunburt or codmans triangle
lesion tthat needs to be surgically or needle biopsy
common treatment of osteosarcoma
amputation or excision of the tumor
chemo
prognosis of osteosarcoma
good with treatment, greater than 10 years at 60-80%
without, death in months
what causes osteosarcoma in older patients
radiation or transformation from pagets disease
osteoporosis
loss of calcium from overactive osteoclasts that results in a demineralization of bone with a normal bone matrix
what is the main complication of osteoporosi
increased risk of fracture
four common of osteoporosis
cushings
hyperparathyroidism
chronic renal disease
involutional
what is the most common type of osteoporosis
involutional
two common drugs that cause osteoporosis
glucocorticoids or heparin
what is the most common bone disorder in the US
what is the gender bias
involutional osteoporosis
why are men at less risk of involutional osteoporosis
men start with a higher bone density
four risk factors for osteoporosis
genetics
smoking
low calcium intake
early menopause
clinical features of osteoporosis
wrist, hip, or vertebrae fracture
loss of height due to fracture
chronic back pain
how is bone density measured
DEXA
treatment of osteoporosis
Ca supplements
estrogen
selective estrogen modulators (SERMs)
bisphosphates
what is the paradox of osteoporosis treatment
there are approved drugs to improve bone density and reduce fractures
BUT
there are significant risks
risks of osteoporosis treatment
estrogens: heart disease and breast cancer
bisphosphonates: jaw osteonecrosis
SERMs: hot flashes
Ca supps: renal caliculi
two types of myalgia for our test
fibromyalgia
polymyalgia rheumatica
how common is fibromyalgia
what is the gender/age bias
common, 3-10%
usually women ages 20-50
clinical findings of fibromyalgia
chronic diffuse pain
fatigue, sleep disorders, headache
increased pain sensation
what is the advantage of SERM treatment in osteoporosis
selectively effects estrogen receptors in bone
four theories for the cuase of fibromyaligia
virus, depression, sleep disorders, central sensitiization
central sensization theory of fibromyalgia
genetic defect in CNS pain signalling the involves cytokines and neurotransmitters (glutamate, dopamine)
how is fibromyalgia diagnosed
physical exam with trigger points
widespread pain for longer than 3 montsh
treatment for fibromyalgia
antidepressants
lifestyle adjustment (stress reduction, exercise, normal sleep)
polymyalgia rheumatica
also has…
pain and stiffness of the shoulder and pelvic muscles causing difficulty combing hair or rising from a chair due to pain, not weakness
also has a low grade fever, weight loss, and malaise
what age is most common for polymyalgia rheumatica
always after age 50, mean 72
what is the etiology of PR
autoimmune disorder with elevated ESR
common treatment of PR
predinsone should produce recovery in 72 hrs or its something else
conitinue low does steroids for 6-12 montsh
special hazard of PR
connection with giant cell arteritis in 1/3 of patients what can cause sudden blindness due to occluding the opthalmic arteries
because of the risk of giant cell arteries, what should all new onset myalgia patients get
sed rate (ESR)
