musculoskeletal - gout and some arthritis Flashcards
Questions regarding diseases that affect the musculoskeletal system and are also inflammatory.
risk factors for osteoarthritis
age obesity (pro-inflammatory state) high impact sports trauma genetics
is osteoarthritis more common in males or females?
more common in men before 45
more common in women after 55
non-inflammatory pathology of osteoarthritis
deterioration of articular cartilage by wear and tear
formation of new bone at the joint surfaces and margins
crepitus
cracking sensation when knee bends
inflammatory pathology of osteoarthritis
proteases metalloproteases catabolic and anabolic cytokines IL-1 TNF-alpha insulin like growth factor TGF-beta
joints most commonly affected by osteoarthritis
knee hip DIPJ PIPJ 1st CMC spine 1st MTPJ
signs of osteoarthritis
muscle wasting
osteophytes
Heberden’s and Bouchard’s nodes
symptoms of osteoarthritis
pain
aggravated by activity
relieved by rest
complications of osteoarthritis
poor mobility and its associated illnesses
where does OA of knees start?
starts medially and moves laterally
XR signs of OA
sclerosis
osteophytes
cysts
asymmetric loss of joint space
diagnostic tests for OA
XR CT isotope bone scan blood tests (ESR, FBC, rheumatoid factor, ALP, calcium) - should all be normal diagnostic injection arthroscopy
what causes the pain in OA?
capsular stretching and vascular congestion of the bone
treatment of osteoarthritis
lifestyle modification and exercise physiotherapy walking aids analgesics (NSAIDs and glucosamine) capsaicin cream steroid injections hyaluronic acid surgery
surgical options for osteoarthritis
debridement of joint realignment of osteotomies joint excision joint fusion (arthrodesis) joint replacement (arthroplasty)
risk factors for rheumatoid arthritis
female caucasian family history smoking HLA DR4 mutation
pathology of rheumatoid arthritis
inflamed synovium proliferates to form pannus –> pannus invades bone –> erosion of bone
destruction of cartilage causes release of proteinases and cytokines
characteristics of inflammatory joint pain
pain eases with use
prolonged stiffness in the morning and at rest
hot and red joint
tends to affect hands and feet
characteristics of degenerative joint pain
pain increases with use
stiffness is not prolonged
stiffness in morning and evening
tends to affect 1st CMCJ, DIPJ, and knees
late signs of rheumatoid arthritis
ulnar deviation
subluxation
Boutonierre deformity (button pressing 2nd digit)
swan neck dextrous deformity
complications of rheumatoid arthritis
vasculitis osteophytes tenosynovitis eye involvement amyloid
eye involvement in rheumatoid arthritis
sicca
secondary Sjogrens
episcleritis
scleritis
what percentage of patients are negative for all rheumatoid investigations?
20%
diagnosis of rheumatoid arthritis
increase rheumatoid factor high ESR CCP increase (highly specific) anaemia anti-cyclic citrullinated peptide do joint aspirate to rule out crystal disease
treatment of rheumatoid arthritis
physiotherapy
surgery
anti-inflammatory drugs
risk factors for gout
genetics diet alcohol male diuretics obesity hypertension
at what level does deposition of uric acid become a risk?
> 0.36 mmol/L
what causes high uric acid levels in gout?
under excretion
over production
pathology of gout
high blood monosodium urate concentration –> crystallisation and deposition in joints –> phagocyte activation –> inflammation
what is the key enzyme in purine metabolism that prevents gout?
xanthine oxidase
symptoms of gout
joint pain
swelling
redness
shiny looking joint (typically base of big toe)
complications of gout
rate nephropathy
kidney stones
tophaceous gout (can ulcerate and get infected)
diagnosis of gout
monosodium urate crystals in synovial fluid (which are blue and yellow under polarised light)
bloods: hyperuricaemia (NB: will be low in acute gout), WBCs, ESR
XR is good for chronic gout
treatment of gout
hydration
NSAIDs or steroids
allopurinol and probenecid for long term reduction of symptoms
vitamin C for prevention
differential diagnosis of gout
sepsis
what should you give to gout patients who have renal problems and so can’t have NSAIDs?
colchicine
risk factors for pseudogout
old age hyperparathyroidism haemachromatosis male gender acromegaly
what is usually deposited at joints in pseudo gout?
calcium phosphate
pathology of acute (spontaneous) pseudogout
monoarthropathy usually in large joints in the elderly
pathology of chronic pseudogout
inflammatory RA-like polyarthritis and synovitis
signs of pseudogout
inflammation
chronic arthritis
symptoms of pseudogout
pain
complications of pseudogout
permanent joint damage
acute synovitis
diagnosis of pseduogout
polarised light microscopy of synovial joint fluid - crystals rhomboid and not colourful
soft tissue calcium deposition
how to treat acute pseudogout
cool packs rest aspiratoin intra-articular steroids NSAIDs
how to treat chronic pseudogout
methotrexate
hydrochloroquine
risk factors for ankylosing spondylosis
HLA B27 (95% patients)
definition of ankylosing spondylosis
a chronic inflammatory disease of the spine and the sacroiliac joints, aetiology unknown.
signs of spondylosing arthritis
SPINE ACHE
Sausage digit (dactylitis) Psoriasis Inflammatory back pain NSAIDs - responds well Enthesitis (inflammation of tendon sheath) Arthritis Crohn's / colitis / elevated CRP HLA-B27 Eye - uveitis
symptoms of ankylosing spondylitis
low back pain radiating from sacro-iliac joints to hips/buttocks
pain improves towards end of day
complications of ankylosing spondylitis
spine fracture
diagnosis of ankylosing spondylitis
clinical diagnosis
MRI to detect bone marrow oedema
XR
bloods
blood tests results for a patient with ankylosing spondylitis
increased ESR and CRP
HLA B27 positive
X-ray results of a patient with ankylosing spondylitis
joint narrowing or widening
sclerosis
erosions
ankylosis/fusion
treatment of ankylosing spondylitis
exercise to maintain posture and mobility
NSAIDs for symptomatic relief
TNF alpha blockers (etanercept, adalimumab)
local steroid injection
