Musculoskeletal Health Flashcards
Name 3 types of arthritis
Osteoarthritis
Rheumatoid arthritis
Gout
Ankylosing spondylitis
Psoriatic arthritis
______________- = degenerative arthritis of the articular cartilage, typically affecting the weight-bearing (larger) joints and seen mostly over the age of 45 years.
Osteoarthritis
List 3 signs/symptoms of osteoarthritis
Joint pain (big, weight bearing joints)
Joint stiffness
Joint swelling / deformity
What are Heberden’s nodes?
Swellings at the distal interphalangeal joints (osteoarthritis)
What is articular cartilage made up of?
Extracellular matrix and chondrocytes
What is extracellular matrix made of?
Water, collagen, proteoglycans
What are proteoglycans (a component of extracellular matrix) made of?
Glycosaminoglycan (GAG) chains such as chondroitin sulphate, bound to hyaluronic acid
Explain the pathophysiology of osteoarthritis
- Proteolytic breakdown of cartilage matrix
- Release of pro-inflammatory mediators
- Level of proteoglycans drop, causing cartilage to soften
- Joint surface integrity becomes compromised.
- Clefts develop along the smooth articular cartilage
- Loss of cartilage results in loss of joint space
- Underlying bone is exposed
- Subchondral bone thickens and bony spurs (osteophytes) develop
List 3 causes/risk factors for osteoarthritis
Increasing age
Previous joint trauma
Overweight/obesity
T2DM
Genetics
Drivers of chronic inflammation (i.e, metabolic endotoxaemia)
Other joint diseases
Nutritional deficiencies
What might you see on radiography / X-ray for osteoarthritis?
Joint space narrowing
Osteophytes
Subchondral sclerosis
How do NSAIDs increase the rate of joint deterioration in osteoarthritis?
Inhibit collagen matrix synthesis
Accelerate cartilage breakdown
List 3 supplements you might prescribe for osteoarthritis
Glucosamin sulphate
Chondroitin sulphate
MSM
Vit C
Vit E
Vit D
Tart cherry
Vit K2
List 2 herbs/nutrients you might prescribe for osteoarthritis.
Turmeric
Boswelia
Devil’s Claw
Ginger
_____________ ______________ = a chronic inflammatory autoimmune disease characterised by synovial joint inflammation, potentially affecting all organs except the brain.
Rheumatoid arthritis
List 2 signs/symptoms of rheumatoid arthritis
- Symmetrical poly-arthritis in small distal joints of hands/feet
- Hand deformities (i.e, swan neck)
- Subcutaneous nodules
List 3 possible complications of rheumatoid arthritis.
C1/2 vertebral subluxation
Pleurisy
Pulmonary fibrosis
Kidney disease
Carpel tunnel syndrome
In which musculoskeletal condition does citrullination occur?
RA
Describe the pathophysiology of RA
- Citrullination occurs.
- Antigen presenting cells recognise citrulline proteins as foreign
- The antigens are presented to T-cells, triggering T-call differentiation.
- B-cells are activated, creating autoantibodies
- Inflammatory cytokines are produced in synovial joints
- Proteases are released, which degrade cartilage and increase osteoclast activity
HLA-DRB1 alleles constitute the largest genetic risk factor for ________ ________
Rheumatoid arthritis
Why is smoking a significant risk factor for RA?
Causes oxidative damage
Raises pro-inflammatory cytokines
Causes epigenetic changes
List 3 causes / risk factors for RA
Genetics
Smoking
Periodontitis
Silica dust exposure
Intestinal dysbiosis
Gut barrier dysfunction
What might you find in a blood test for RA?
- Raised inflammatory markers (CRP/ESR)
- Rheumatoid factor
- Anti-citrullinated protein antibodies
Which musculoskeletal condition is methotrexate commonly used for?
RA
_________ = arthritis due to deposition of uric acid crystals within joints, causing acute inflammation.
Gout
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
Which is the key cytokine mediating inflammation in gout?
Interleukin-1B
Describe the pathophysiology of gout
- Purine-rich foods eaten
- Metabolism of foods releases purines in the ingested DNA/RNA
- Uric acid is formed in the metabolism of purines
- Hyperuricaemia causes crystal formation
- Interleukin-1B drives inflammation
List 2 co-morbidities of gout
Hypertension
CVD
T2DM
Kidney disease
Why should you avoid getting the feet cold in gout?
Uric acid deposits easily in cold weather
List 3 supplements you might use in gout
Quercetin
EPA
Methyl folate
Tart cherry
Celery juice
Nettle tea
_____________ = a condition of chronic widespread pain and abnormal pain-processing mechanisms
Fibromyalgia
List 3 signs/symptoms of fibromyalgia
Chronic widespread pain
Fatigue
Sleep disturbance
Stiffness
Headaches
Bowel disturbances
Anxiety & depression
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
Why is hypothyroidism a risk factor for fibromyalgia?
Thyroid hormones normally inhibit the synthesis and secretion of substance P in the CNS
Sauna therapy can improve fibromyalgia. True or false?
True
Back pain is broadly categorised as being ____________ or _____ ____________.
Mechanical or non-mechanical
When is a condition referred to as chronic
After 12 weeks duration
If inflammation is a key feature in back pain, the pain is often relieved by ____________.
Movement
Morning stiffness is also common with inflammation.
List 3 possible causes of non-mechanical back pain
Ankylosing spondylitis
Endometriosis
Fibromyalgia
Shingles
Renal disease
Malignancy
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
Over 90% of ankylosing spondylitis patients have the ___-_____ gene
HLA-B27
List 2 causes / risk factors for ankylosing spondylitis
Genetic
Biomechanical stress
Microbials
GI inflammation
Gut dysbiosis
Impaired intestinal barrier
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
Which musculoskeletal pathology is asymptomatic until a fracture occurs?
Osteoporosis
Fractures of which bone(s) correlate with a 20-40% increase in mortality?
Hip fractures
Define osteoporosis
Low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.
Osteoporosis results from osteoclast bone resorption not being compensated by osteoblast bone formation.
True or false?
True
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
Which scan is commonly used to investigate osteoporosis?
DEXA scan
