Musculoskeletal Health Flashcards

1
Q

Name 3 types of arthritis

A

Osteoarthritis
Rheumatoid arthritis
Gout
Ankylosing spondylitis
Psoriatic arthritis

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2
Q

______________- = degenerative arthritis of the articular cartilage, typically affecting the weight-bearing (larger) joints and seen mostly over the age of 45 years.

A

Osteoarthritis

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3
Q

List 3 signs/symptoms of osteoarthritis

A

Joint pain (big, weight bearing joints)
Joint stiffness
Joint swelling / deformity

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4
Q

What are Heberden’s nodes?

A

Swellings at the distal interphalangeal joints (osteoarthritis)

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5
Q

What is articular cartilage made up of?

A

Extracellular matrix and chondrocytes

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6
Q

What is extracellular matrix made of?

A

Water, collagen, proteoglycans

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7
Q

What are proteoglycans (a component of extracellular matrix) made of?

A

Glycosaminoglycan (GAG) chains such as chondroitin sulphate, bound to hyaluronic acid

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8
Q

Explain the pathophysiology of osteoarthritis

A
  1. Proteolytic breakdown of cartilage matrix
  2. Release of pro-inflammatory mediators
  3. Level of proteoglycans drop, causing cartilage to soften
  4. Joint surface integrity becomes compromised.
  5. Clefts develop along the smooth articular cartilage
  6. Loss of cartilage results in loss of joint space
  7. Underlying bone is exposed
  8. Subchondral bone thickens and bony spurs (osteophytes) develop
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9
Q

List 3 causes/risk factors for osteoarthritis

A

Increasing age
Previous joint trauma
Overweight/obesity
T2DM
Genetics
Drivers of chronic inflammation (i.e, metabolic endotoxaemia)
Other joint diseases
Nutritional deficiencies

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10
Q

What might you see on radiography / X-ray for osteoarthritis?

A

Joint space narrowing
Osteophytes
Subchondral sclerosis

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11
Q

How do NSAIDs increase the rate of joint deterioration in osteoarthritis?

A

Inhibit collagen matrix synthesis
Accelerate cartilage breakdown

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12
Q

List 3 supplements you might prescribe for osteoarthritis

A

Glucosamin sulphate
Chondroitin sulphate
MSM
Vit C
Vit E
Vit D
Tart cherry
Vit K2

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13
Q

List 2 herbs/nutrients you might prescribe for osteoarthritis.

A

Turmeric
Boswelia
Devil’s Claw
Ginger

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14
Q

_____________ ______________ = a chronic inflammatory autoimmune disease characterised by synovial joint inflammation, potentially affecting all organs except the brain.

A

Rheumatoid arthritis

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15
Q

List 2 signs/symptoms of rheumatoid arthritis

A
  • Symmetrical poly-arthritis in small distal joints of hands/feet
  • Hand deformities (i.e, swan neck)
  • Subcutaneous nodules
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16
Q

List 3 possible complications of rheumatoid arthritis.

A

C1/2 vertebral subluxation
Pleurisy
Pulmonary fibrosis
Kidney disease
Carpel tunnel syndrome

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17
Q

In which musculoskeletal condition does citrullination occur?

A

RA

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18
Q

Describe the pathophysiology of RA

A
  1. Citrullination occurs.
  2. Antigen presenting cells recognise citrulline proteins as foreign
  3. The antigens are presented to T-cells, triggering T-call differentiation.
  4. B-cells are activated, creating autoantibodies
  5. Inflammatory cytokines are produced in synovial joints
  6. Proteases are released, which degrade cartilage and increase osteoclast activity
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19
Q

HLA-DRB1 alleles constitute the largest genetic risk factor for ________ ________

A

Rheumatoid arthritis

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20
Q

Why is smoking a significant risk factor for RA?

A

Causes oxidative damage
Raises pro-inflammatory cytokines
Causes epigenetic changes

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21
Q

List 3 causes / risk factors for RA

A

Genetics
Smoking
Periodontitis
Silica dust exposure
Intestinal dysbiosis
Gut barrier dysfunction

22
Q

What might you find in a blood test for RA?

A
  • Raised inflammatory markers (CRP/ESR)
  • Rheumatoid factor
  • Anti-citrullinated protein antibodies
23
Q

Which musculoskeletal condition is methotrexate commonly used for?

24
Q

_________ = arthritis due to deposition of uric acid crystals within joints, causing acute inflammation.

25
List 2 signs/symptoms of gout
Monoarticular arthritis (usually big toe) Pain, swelling, redness, heat Shiny skin Pain can awaken patients from sleep Inability to use the joint during symptomatic episode Fever and malaise
26
Which is the key cytokine mediating inflammation in gout?
Interleukin-1B
27
Describe the pathophysiology of gout
1. Purine-rich foods eaten 2. Metabolism of foods releases purines in the ingested DNA/RNA 3. Uric acid is formed in the metabolism of purines 4. Hyperuricaemia causes crystal formation 5. Interleukin-1B drives inflammation
28
List 2 co-morbidities of gout
Hypertension CVD T2DM Kidney disease
29
Why should you avoid getting the feet cold in gout?
Uric acid deposits easily in cold weather
30
List 3 supplements you might use in gout
Quercetin EPA Methyl folate Tart cherry Celery juice Nettle tea
31
_____________ = a condition of chronic widespread pain and abnormal pain-processing mechanisms
Fibromyalgia
32
List 3 signs/symptoms of fibromyalgia
Chronic widespread pain Fatigue Sleep disturbance Stiffness Headaches Bowel disturbances Anxiety & depression
33
List 3 causes/risk factors for fibromyalgia
Trauma - physical and emotional Disrupted cortisol levels Hypothyroidism Intestinal dysbiosis SIBO Infections (e.g., EBV) Nutritional deficiencies (D, B12, Mg) Gluten reactivity Gene SNPS (methylation & detoxification) Heavy metals
34
Why is hypothyroidism a risk factor for fibromyalgia?
Thyroid hormones normally inhibit the synthesis and secretion of substance P in the CNS
35
Sauna therapy can improve fibromyalgia. True or false?
True
36
Back pain is broadly categorised as being ____________ or _____ ____________.
Mechanical or non-mechanical
37
When is a condition referred to as chronic
After 12 weeks duration
38
If inflammation is a key feature in back pain, the pain is often relieved by ____________.
Movement Morning stiffness is also common with inflammation.
39
List 3 possible causes of non-mechanical back pain
Ankylosing spondylitis Endometriosis Fibromyalgia Shingles Renal disease Malignancy
40
List 3 signs/symptoms of Ankylosing Spondylitis
Chronic back pain and stiffness (especially AM) Peripheral inflammation at bone-tendon attachments Uveitis Psoriasis IBD Fever Fatigue Thoracic kyphosis
41
Over 90% of ankylosing spondylitis patients have the ___-_____ gene
HLA-B27
42
List 2 causes / risk factors for ankylosing spondylitis
Genetic Biomechanical stress Microbials GI inflammation Gut dysbiosis Impaired intestinal barrier
43
What 3 things mightList 3 things you might do in a natural approach to ankylosing spondylitis
CNM diet Exclude dairy Low starch diet Fasting Restore gut health Manual therapy Mobility exercises Breathing exercises
44
Which musculoskeletal pathology is asymptomatic until a fracture occurs?
Osteoporosis
45
Fractures of which bone(s) correlate with a 20-40% increase in mortality?
Hip fractures
46
Define osteoporosis
Low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.
47
Osteoporosis results from osteoclast bone resorption not being compensated by osteoblast bone formation. True or false?
True
48
List 3 causes / risk factors for osteoporosis
Increasing age Female / post menopause - oestrogen deficient state Low body weight High dairy intake High red meat Nutrient deficiencies (vit D, Ca, Mg) Carbonated beverages (phosphoric acid) Caffeine Alcohol Smoking Inactivity Hypochlorhydria - Ca must be ionised by HCl Inflammation Drugs Gut dysbiosis - Vit K2 production by commensals
49
Which scan is commonly used to investigate osteoporosis?
DEXA scan
50