Non-Inflammatory Monoarticular and Polyarticular

Question 1

AVN Atraumatic:

Answer 1

• Disruption of blood supply to bones
• Glucocorticoids (long term use is greatest risk for AVN) and Excessive Alcohol are most common cause of atraumatic AVN
• SLE + Glucocorticoids = greatest risk of developing AVN
• Sickle Cell Disease
• Gaucher’s Disease -> Accumulation of cerebroside in cells of the bone marrow decreasing blood supply
• Bisphosphonates long term -> keep building new bone without breaking down the old bone

Question 2

How Glucocorticoids cause AVN:

Answer 2

• Increase in lipids causing micro emboli
• Increase in BM fat cell size and number blocking blood flow
• Change in venous endothelial cells leading to stasis increased interosseous pressure and necrosis

Question 3

AVN Traumatic:

Answer 3

• Fractures

- Subcapital region of femoral neck, Scaphoid, Lunate at greatest risk

Question 4

Most common presenting symptom of AVN:

Answer 4

PAIN

Question 5

How to image AVN?

Answer 5

MRI

Question 6

Hemochromatosis:

Answer 6

• Hereditary hemochromatosis causes an increase in iron absorption
• Screening for HH by calculating Transferrin Saturation
• Iron deposits in soft tissue causing ARTHRALGIA
• Development of arthritis cannot be predicted by iron levels
• Pain in small hand joints mainly 2nd and 3rd metacarpals are most common symptoms
• Phlebotomy + Deferoxamine

Question 7

OA:

Answer 7

Idiopathic Arthritis:
-Localized Hands feet knee hip spine most common
-Generalized 3+ joints
Secondary OA: specific conditions that cause or augment OA development
Two MOI:
-Damage to normal articular cartilage
-Defective cartilage fails under normal force
-Age is strongest risk factor
-Obesity is strongest modifiable risk factor
-Joint pain that is exacerbated by activity
-Joint stiffness in morning and happens at rest -> Articular gelling
-Subchondral sclerosis

Question 8

Heberden’s Nodes:

Answer 8

DIP Joint only and only in OA

Question 9

Bouchard’s Nodes:

Answer 9

PIP Joint only and in both OA and RA

Question 10

OA in Knee:

Answer 10

Cartilage loss initially at medial aspect resulting in varus angulation

Question 11

OA in Spine:

Answer 11

• Most commonly T5, C8, L3

- Osteophyte formation