Musculoskeletal

Question 1

What is a general description of Rheumatoid arthritis?

Answer 1

Chronic inflammatory symmetrical polyarthropathy

Question 2

What is a general description of Osteo Arthritis?

Answer 2

Degenerative arthropathy due to wear and tear

Question 3

What is a general description of Gout?

Answer 3

Crystal arthropathy arising from increased production / intake or insufficient excretion of purines.

Crystals deposit in joints causing inflammation

Question 4

What are the relevant path and histology findings for Rheumatoid arthritis?

Answer 4

Synovitis and tendosynovitis
Pannus formation (hyperplastic synovium)
Fibrous ankylosis
Bony ankylosis

Question 5

What are the relevant path and histology findings for Osteo arthritis?

Answer 5

Articular cartilage damage, fragmentation and erosion

X-RAY (LOSS) - loss of joint space, osteophytes, subchondral cysts, subchondral sclerosis

Question 6

What are the relevant path and histology findings for Gout?

Answer 6

Foreign body granuloma.
Clusters of negatively birefringent crystals
Macrophages and multinucleated giant cells

Question 7

What sites are typically involved or spared in Rheumatoid arthritis?

Answer 7

Affected: MCP, PIP, MTP, Elbow (painful fixed flexion), shoulder, knee, hip, cervical spine (atlanto-axial subluxation)

Spared: DIPs and thoracolumbar

Question 8

What sites are typically involved or spared in Osteo arthritis?

Answer 8

Affected: Large weight bearing joints (hips, knees), CMC, PIP, DIP

Question 9

What sites are typically involved or spared in Gout?

Answer 9

Affected: Feet (first metacarpal - podagra) and ankle are common, but can be any joint

Question 10

What are the main risk factors for Rheumatoid arthritis?

Answer 10

HLA-DR4, Female gender, FHx, smoking

Question 11

What are the main risk factors for Osteo arthritis?

Answer 11

Overuse, obesity, >50yo

Question 12

What are the main risk factors for Gout?

Answer 12

Male gender, diuretics, high purine diet, metabolic syndrome, CKD, tumour lysis syndrome

Question 13

What is the typical history for Rheumatoid Arthritis?

Answer 13

Inflammatory symptoms, bogginess, decreased function (opening jars, using keys)

Question 14

What is the typical history for Osteo arthritis?

Answer 14

Morning stiffness <30 mins
Worse with activity
Loss of movement
Instability
Crepitus
Knees locking or giving way

Question 15

What is the typical history for Gout

Answer 15

Acute: Severe pain, oedema, erythema, often follows a trigger (alcohol)

Chronic: Deformity, gouty tophi

Question 16

What are the extra-articular manifestations of Rheumatoid arthritis?

Answer 16

Rheumatoid nodules, AMI, peri/endocarditis, LVF, fibrosis, Sjogren’s syndrome, uveitis, scleritis, GNs, Peripheral neuropathy

Question 17

What are the main complications of Gout?

Answer 17

Bone erosion

Urolithiasis

Question 18

What are the antibodies present in rheumatoid arthritis?

Answer 18

RF, Anti-CCP, ANA

Question 19

What are the chronic treatments for RA?

Answer 19

Corticosteroids
Methotrexate + Folic acid
Hydroxychloroquine

bDMARDS: Infliximab, retuximab

Question 20

What is the acute management of gout?

Answer 20

1. NSAIDS
2. Colchicine
3. Corticosteroids
4. IL 1 inhibitor
5. Urate lowering drugs (don’t stop)

Question 21

What is the chronic management of gout?

Answer 21

1. Xanthine oxidase inhibitor (alopurinol, febuxostat)
2. Probenacid
3. uriolytics