Musculoskeletal History Glossary

Question 1

Osteoarthritis

Answer 1

Osteoarthritis is a disease of synovial joints which is characterised by loss of articular cartilage and overgrowth of the underlying bone. Unlike rheumatoid arthritis, there is no pannus.

In the past osteoarthritis was considered to be a “degenerative joint disease”, implying a passive process associated with old age. This is misleading because osteoarthritis is a multifactorial, active disease which usually begins in middle age.

Osteoarthritis is in fact a loosely defined group of diseases which may be triggered by factors such as:

-mechanical damage
-inflammation-
metabolic defects

Question 2

Rheumatoid arthritis

Answer 2

Rheumatoid arthritis is a chronic systemic disease that primarily affects the joints. Presentation is typically as an insidious polyarthritis characterised by inflammatory changes in the synovial membranes and articular structures leading to deformity and ankylosis. Systemic features usually develop as the disease progresses.

• RA affects between 0.5% and 1% of the population
• approximately 400,000 people in England and Wales have this condition.
• incidence of the condition is around 1.5 men and 3.6 women developing RA per 10,000 people per year. translates into approximately 12,000 people developing RA per year in the UK
• overall occurrence of RA is two to four times greater in women than men. The peak age of incidence in the UK for both genders is the 70s, but people of all ages can develop the disease (3)
• life expectancy of people with RA is reduced by 5 -10 years compared with that of people without the condition, and 35 - 50% of this excess risk is accounted for by cardiovascular (CV) mortality

approximately one third of people stop work because of the disease within 2 years of onset, and this prevalence increases thereafter. The total costs of RA in the UK, including indirect costs and work-related disability, have been estimated at between £3.8 and £4.75 billion per year (3)
The cause is unknown, but an autoimmune mechanism involving viral infection has been postulated.

Question 3

Ankylosis

Answer 3

abnormal stiffening and immobility of a joint due to fusion of the bones.

Question 4

Gout

Answer 4

Gout is a painful and potentially disabling form of inflammatory arthritis that has been recognized since ancient times.

Question 5

degenerative disease

Answer 5

degenerative disease implies a passive process associated with old age.

Question 6

soft-tissue rheumatism

Answer 6

This term encompasses a number of conditions which arise from the soft tissue structures surrounding a joint.

These conditions are mostly benign and self limiting though in some cases they may result in long-term sufering and disability.

Question 7

fibromyalgia

Answer 7

The diagnosis of fibromyalgia is based on a history of chronic widespread pain (CWP) and the presence of at least 11 out of 18 specified ‘tender points’ (see below)

Question 8

Septic arthritis

Answer 8

Septic arthritis is a suppurative inflammation within a joint space, most commonly due to haematogenous spread, but sometimes due to direct spread from a penetrating wound or a neighbouring infection, for example chronic osteomyelitis.

Most commonly affected are children, premature neonates, the elderly and the immune suppressed.

Generally, this disease is monoarticular, and occurs often in the knee and the hip, but may involve any joint. In infants there can be multiple joint involvement. Note that septic arthritis of the hip may present as pain in the knee and vice-versa.

Question 9

Stiffness

Answer 9

Stiffness is an inability to get the joints moving after rest.

Question 10

in past medical history, how do you ask about medical conditions?

Answer 10

“I’m going to run through a few conditions to make sure we didn’t miss anything out.”

Question 11

Inflammatory bowel disease (IBD)

Answer 11

Inflammatory bowel disease (IBD) term embraces a group of idiopathic chronic inflammatory intestinal conditions which include two main disease categories with similar, but distinct, pathological conditions:

ulcerative colitis
Crohn’s disease (1)
The pathogenesis of IBD is unknown (1). There are many overlapping clinical, radiological, endoscopic, and histological characteristics, but equally, there are clear differences in the distribution and depth of inflammation within the gastrointestinal tract.

Crohn’s disease is a transmural process that may affect any part of the gastrointestinal tract, whereas in uncomplicated ulcerative colitis, inflammation is confined to the colonic mucosa.

Question 12

Psoriasis

Answer 12

Psoriasis is a common chronic skin disease characterised by cutaneous inflammation and epidermal hyperproliferation - lesions appear on any part of the skin, but particularly the scalp, sacral area, and over the extensor aspect of the knees and elbows

the major manifestation of psoriasis is the chronic skin disease (although psoriatic joint disease is another major morbidity associated with psoriasis)