Musculoskeletal Disorders Flashcards
what is arthritis?
inflammation of joints
what is arthrosis?
non-inflammatory joint disease
what is arthralgia?
joint pain
what type of tissue is bone?
connective
what are the 3 main features of bone?
load bearing
dynamic
self repairing
what is the function of osteoclasts?
responsible for aged bone resorption
they eat away the bone matrix
what is the function of osteoblasts?
responsible for new bone formation
how long does the bone turnover cycle take?
3-6 months
what does the bone turnover cycle require?
correct amounts of calcium, phosphate and vitamin d
What is stored within bone?
calcium
what is the function of the parathyroid hormone?
a hormone your parathyroid glands release to control calcium levels in your blood
what is hyperparathyroidism?
where the parathyroid glands (in the neck, near the thyroid gland) produce too much parathyroid hormone
what is hypoparathyroidism?
parathyroid glands, which are in the neck near the thyroid gland, produce too little parathyroid hormone.
what causes primary hyperparathyroidism and what can it lead to?
can be due to tumours, resulting in high serum calcium levels and inappropriate activation of osteoclasts
what causes secondary hyperparathyroidism and what can it lead to?
can be due to low serum calcium, this will activate osteoclasts in bone to try maintain the level
how can you receive vitamin D?
produced from sunlight through cholecalciferol in the skin
absorbed from the diet
vitamin D problems
low sunlight exposure
poor GI absorption
drug interactions
due to the pigment in the skin, darker skinned people absorb less vitamin D less efficiently
what is osteomalacia?
a condition where bones become soft and weak.
poorly mineralised osteoid matrix
poorly mineralised cartilage growth plate
The most common cause is not having enough vitamin D
what is osteoporosis?
weakens bones to the point that they can break easily
loss of mineral and matrix - reduced bone mass
It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break (fracture)
what is rickets?
Rickets is a condition that affects bone development in children. It causes bone pain, poor growth and soft, weak bones that can lead to bone deformities
when osteomalacia happens during bone formation a disease called rickets results. after bone formation is completed the disease is termed osteomalacia
what causes osteomalacia?
calcium deficiency
effects of osteomalacia?
BONE EFFECTS
bones bend under pressure - ‘bow legs’
vertebral compression in adults
bones ‘ache’ to touch
HYPOCALCAEMIA EFFECTS\
muscle weakness
trousseau and chvostek signs positive
risk factors of osteoporosis
age
female>male
oestrogen and testosterone deficiency
cushings syndrome
genetic - family history, race, early menopause
inactivity
smoking
alcohol consumption
diet - lack of calcium
steroids
anti-epileptics
why is osteoporosis more common in females than males?
the hormone changes that happen at the menopause directly affect bone density.
oestrogen withdrawal increases bone mass loss
what is peak bone mass age?
24-35yrs
what drugs are used to treat osteoporosis?
bisphosphonates
osteoporosis prevention
exercise
high dietary calcium intake
oestrogen hormone replacement therapy - most effective if early menopause
what is hormone replacement therapy?
Hormone replacement therapy (HRT) is a treatment to relieve symptoms of the menopause. It replaces hormones that are at a lower level as you approach the menopause
how do bisphosphonates work?
They act by preventing osteoclast action, by poisoning the osteoclast and reducing their numbers. If there are reduced osteoclasts, less bone can be removed therefore bone mass can be preserved
what are the 4 main types of bisphosphonates?
alendronate
ibandronate
zolendronate
risendronate
what does the higher the potency of a drug mean?
means the drug will be taken less
what is osteocrenosis?
blood flow to part of a bone is disrupted
where is commonly effected by osteonecrosis due to an invasive dental procedure?
the jaw
symptoms of joint disease
pain
immobility stiffness
loss of function
how to investigate joint disease?
radiography
blood tests
arthroscopy and biopsy
what is crepitus?
noise made by bone ends moving
example of arthropathies
gout
what are crystal arthropathies?
a group of joint disorders caused by deposits of crystals in joints and the soft tissues around them
what are acute monoarthropathies?
only affects one joint in the body
what is gout
Gout gives you acute arthritis of a single joint but it can also be caused by a septic arthritis where an infection has got in to a joint. Uric acid crystals are deposited in the joint and cause inflammation, causing significant pain
what does hyperuricaemia mean?
high uric acid levels
causes of hyperuricaemia
drug induced - thiazide diuretics
genetic predisposition
chemotherapy
tumour related - myeloma
obesity and alcohol consumption
less common in women until menopause - then equalises
gout symptoms
acute inflammation of single joint
rapid onset
what is prescribed to treat gout?
NSAIDS
dental aspects of gout
avoid aspirin - interferes with uric acid removal
drug treatments may give oral ulceration (allopurinol)
what is osteoarthritis?
most common form of arthritis
degenerative joint disease
where does osteoarthritis most commonly effect?
hips and knees
symptoms of osteoarthritis
pain that improves with rest and worsens with activity
brief morning sickness
slowly progressive over years
how to test for osteoarthritis
radiographs
treatment for osteoarthritis
NSAIDS
joint replacement
dental aspects of OA
TMJ can be involved
chronic NSAID use - oral ulceration, anti platelets can lead to increased bleeding
what is rheumatoid arthritis?
initially an autoimmune disease of the synovium with gradual inflammatory joint destruction
main difference between osteoarthritis and rheumatoid
rheumatoid is not a disease of old age like osteoarthritis , starts earlier on in life and progresses from there
where does rheumatoid arthritis effect?
it is a symmetrical polyarthritis and effects all synovial joints in the body
symptoms of RA?
joint swelling
fever
slow onset - initially hands and feet
weight loss
investigations of RA
radiographs
blood tests
drugs used to treat RA
analgesics - paracetamol, cocodomol
NSAIDS
steroids
disease modifying drugs - hydroxychloroquine, methotrexate
dental aspects of RA
reduced dexterity
access to care
sjogrens sydrome - dry mouth
drug effects - bleeding, ulceration, pigmentation
what RA drug can cause oral lichenoid reactions
sulphasalazine
hydroxychloroquinone
what RA drug can cause oral ulceration
methotrexate
what RA drug can cause oral pigmentation
hydroxychloroquinone
what is seronegative spondyloarthritides
a family of joint disorders that classically include;
ankylosing spondylitis
reiter’s disease
arthritis of IBD
effects of ankylosing spondylitis
disabling progressive lack of axial movement
lower back pain
cervical spine tipped forward (kyphosis)
treatment for ankylosing spondylitis
analgesia
NSAIDS
physio
occupational therapy
surgery
