Musculoskeletal: explanation and treatment

Question 1

Osteoarthritis: Xray features?

Answer 1

LOSS
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- Subchondral cysts

Question 2

Osteoarthritis
- Normal physiology
- Pathophysiology and symptoms
- Causes/risk factors

Answer 2

Normal physiology
- The ends of your bones are covered in cartilage - lubricated surface, allowing the bones to glide against each other.

Pathophysiology
- Osteoarthritis is a condition where the cartilage lining the ends of the bones breaks down
- Causes the bones to rub against each other –> pain
- Bone tries to compensate by forming new growhts –> additional pain, stiffness, loss of motion
- Can affect various joints - including hip, knee, hands and feet, spine

Causes
- Stress over time: eg. age, obesity, injury to joints, overuse
- Family history: genetic aspect

Question 3

Osteoarthritis
- Treatment?

Answer 3

Lifestyle: physical activity, weight loss

Medications:
- Pain relief: NSAIDs –> paracetamol –> short term opioids (eg. tramadol)
- Intraarticular glucocorticoid injections: short term relief

Surgery
- Partial or complete joint replacement (arthroplasty)
- Arthrodesis: surgical fusion of two bones

Question 4

Rheumatoid arthritis
- Xray features?

Answer 4

NEEDS
Narrowing of joint space
Erosions
Effusions
Decreased bone density
Soft tissue swelling

Question 5

Rheumatoid arthritis
- Normal physiology
- Pathophysiology and symptoms
- Causes/risk factors

Answer 5

Draw a joint
- This is a joint, there are two bones.
- This is the inner lining of your joint. Consists of 1) cartilage, 2) synovium.

Your immune system is the army of your body, it fights off bacteria and viruses to prevent us getting unwell. Usually, the immune system doesn’t attack your body’s own tissues.

Pathophysiology
- Immune system attacks the inner lining of your joint.
- Causes inflammation: pain, swelling, stiff. More broadly fever.

Cause
- Don’t know: genes + environmental trigger.

Question 6

Rheumatoid arthritis
- Treatment?

Answer 6

The goal of treatment is to a) manage symptoms and b) reduce inflammation and subsequent damage to your joints.

Lifestyle
- Heat/cold packs to relieve pain
- Improve mobility with gentle exercise, physical/occupational therapy

Medications
- Short term: steroids (systemic, intraarticular) + NSAIDs
- Long term: DMARDs (conventional or biologic)

Surgery
- Total joint replacement
- Synovectomy