Musculoskeletal Disorders Flashcards
Osteoarthritis is…
- Osteoarthritis is often referred to as a dysfunctional ‘wear and tear’ process within the joint.
- An initial imbalance in cartilage homeostasis leads to cartilage degradation, remodeling of bone and associated inflammation of the joint.
- Rather than simply causing joint tissue damage by wear and tear, excessive or abnormal joint loading stimulates joint tissue cells to produce proinflammatory factors and proteases that mediate joint tissue destruction.
- Over time, the cartilage thins, leading to exposure of the underlying subchondral bone. This causes subchondral sclerosis and the continuous remodeling of subchondral bone, which then leads to bone hypertrophy and formation of subchondral cysts and osteophytes. And eventual loss of joint space.
Common sites of Osteoarthritis are…
Common sites: Knees, Hand (DIP, 1st CMC [carpometocarpal]), hip, feet (1st metatarsophalangeal joint-MPJ), spine
However, can occur in any joint
The 1st CMC joint is…
Carpal (wrist) bone + a Metacarpal (or long bone of the thumb)
Incidence of OA
25% of population
More common in women than in men
Risk factors for OA
- Increasing age: 50+
- Women
- Genetic predisposition; distal interphalangeal (DIP) joint involvement
- Trauma (previous fractures, ligamentous injuries, or occupational related repetitive stress)
- Altered joint anatomy or instability
- Obesity
- Secondary inflammation such as infections, inflammatory arthropathies and metabolic disorders
- Metabolic (gout)
- Endocrine (hyperparathyroidism can cause bone thinning)
Common complaints of OA include:
- Unilateral joint pain frequently involving the joints of the hands, neck, lower back, knees and hips
- Morning stiffness lasting less than 1 hour.
- Tenderness, bony prominence, and crepitus of affected joints.
Where are Bouchard’s nodes located?
PIP: Proximal Interphalangeal joints
Where are Herberden’s nodes located?
DIP: Distal Interphalangeal joints
Diagnostics for OA include…
- Radiographs (x-rays) of the joint affected
- ESR (OA does not cause increased ESR)
- Chem panel
- CBC
- Rheumatoid Factor
- CT scan or MRI: considered with nerve impingement syndrome (spine) or spinal stenosis
What is Reiter’s disease?
Reiter’s: reaction to an infection by certain bacteria. Most often, these bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and Yersinia).
Why should you ask about rashes when someone comes in complaining about joint pain?
Because it could be due to Lyme’s disease (one differential diagnosis for arthritis).
Additional differentials diagnoses for OA and RA include:
- Psoriatic arthritis
- Ankylosing Spondylitis
- CPPD: Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (pseudo gout)
- Gout
- Septic arthritis
- Inflammatory Bowel Disease
- Reiter’s disease (Reactive Arthritis)
- Lupus
- Fibromyalgia
- Tendinitis, soft tissue injury
- Osteoporosis
- Multiple myeloma
First line pharmaceutical therapies for OA include:
- Topical NSAIDs, in patients with one or a few joints affected, especially knee and/or hand. Similar efficacy compared with oral NSAIDs and better safety profile
- Oral NSAIDs in patients with inadequate symptom relief from topical NSAIDs, symptomatic OA in multiple joints, and/or patients with hip OA.
- The use of NSAIDs in most patients is limited by the increased risk of serious gastrointestinal, cardiovascular, and renal complications.
- Caution in patient w/comorbidities such as DM, HTN, and advanced age. Consider using COX-2 selective NSAID (e.g., Celebrex) or a nonselective NSAID associated with a proton-pump inhibitor.
- High caution with high comorbidity risk (eg, previous gastrointestinal bleeding or chronic renal failure, cardiovascular disease).
Additional pharmaceutical treatment for OA:
- Duloxetine for patients with OA in multiple joints and concomitant comorbidities that may contraindicate oral NSAIDs and for patients with knee OA who have not responded satisfactorily to other interventions.
- Topical capsaicin is a treatment option when one or a few joints are involved and other interventions are ineffective or contraindicated
- Intraarticular glucocorticoid injection (though are due to the short duration of its effects (ie, approximately four weeks) and evidence that it may have deleterious effects on the hyaline cartilage may accelerate OA progression
- Narcotic analgesics – rarely due to side effect
- Acetaminophen - not first line
- Hyaluronic acid injections -hyaluronic acid in synovial fluid breaks down. Loss of hyaluronic acid appears to contribute to joint pain and stiffness
- Platelet-rich plasma (PRP) -lack of solid evidence for the recommendation. Pain relief up to 12 months post-injection
- Nutraceauticals (glucosamine, chondroitin, MSM) -May take 6 to 8 weeks for improvement
Rheumatoid Arthritis is…(Choose all of the appropriate answers).
A. More common than Osteoarthritis
B. Is a systemic disease and not limited to the joints
C. Is unilateral in symtomatology
D. Involves joint stiffness that does not resolve in less than 1 hour for greater than 6 weeks
E. Is more common in Women than Men
F. All of the above.
Answers:
B, D, E
Not A because OA is more common than RA (25% incidence compared to 1%)
Not C because RA typically involves bilateral inflammation of joints
Not F…because see above.
True or False: The pathogenesis of RA is unknown.
True: The cause of RA is unknown. Articular inflammation results in joint destruction. Antibody formation in the joint area results in inflammation and pain.