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MSKJaz > OA and crystal arthropathies > Flashcards

OA and crystal arthropathies Flashcards

1
Q

pathogenesis of OA:
___ lost, cytokine release (eg. 4) by chondrocytes,
___ cartilage and ___ formation

A

cartilage matrix
IL-1,TNFα, MMPs, prostaglandin
fibrillated
osteophyte

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2
Q

mechanical pain is worse __+__

A

on movement and at the end of day

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3
Q

hand signs of OA

A

squaring of the thumb
Heberdens (DIPJ)
Bouchards (PIPJ)

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4
Q

spine signs of OA

A

C spine pain and reduced movement
maybe nerve impingement
lumbar spine involvement may = spinal stenosis

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5
Q

knee signs of OA

A

osteophytes, effusion, crepitus
genu varum/valgus
Bakers cyst

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6
Q

risk factors for OA

A 
>40 yo
F
occupation
injury/abnormal biomechanics
obesity
comorbidities
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7
Q

Ix for OA

A 
blood test (inflam markers usually normal)
xray (osteophyte, lost joint space, subchondral sclerosis.., bony cysts)
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8
Q

Management of OA

A

physio
wt loss
podiatry +OT
analgesia - paracetamol, NSAIDs, capsaicin, tricyclics
possibly intra art steroids / replacement

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9
Q

monosodium urate crystal deposition => inflam =

A

gout

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10
Q

gout:
M:F

A

M>F

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11
Q

hyperuricaemia = serum levels ___

A

> 7mg/dl or 0.42mmol/l

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12
Q

risk of developing gout is proportional to degree of ___ but is not the same thing!

A

hyperuricaemia

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13
Q

overproduction causes of gout

A

genetic (Lysch-Nyhan, Von Gierke)
psoriasis, malig, haem and pernicious anaemia, bleeding, exercise, obesity, infection
foods high in purones - offal, red meat, shellfish

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14
Q

genetic disorder that is hypoxanthine guanine phosphoribosyltransferase deficiency

A

Lysch-Nyhan

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15
Q

glucose 6 phosphatase deficiency genetic disorder

A

Von Gierkes

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16
Q

underexcretion causes of gout

A 
renal impairment
starvation
dehydration
hypothyroid
hyperPT
alcohol
drugs - levodopa, diuretics, cyclosporin A, pyrazinamide
17
Q

gout is precipitated by ___ in ___ levels

A

acute changes in uric acid levels

18
Q

presentation of gout =

A

red and hot, severely painful monoarthritis for <=2wks

usually 1st MTP > ankle >knee>upper limb >spine

19
Q

chronic polyarticular gout is usually after ___ acute for more than ___, have ___ and often __ associated

A

recurrent >10yrs
tophi
diuretic

20
Q

gold standard Ix for gout

A

joint aspiration and bifringence microscopy

21
Q

management of acute gout =

A

NSAIDs or colchicine (if contraind to NSAIDs)
steroids
analgesia

22
Q

lifestyle management of gout

A

decrease alcohol intake, purine high foods, weight
avoid fructose high drinks
2l fluids per day at least

23
Q

prophylaxis for gout is given if ____

Rx =

A

> 2 attacks, tophi, xray erosions, renal stones

urate lowering - allopurinol/febuxostat

24
Q

start urate lowering drugs eg allopurinol ____
start on a __ dose and ___
aim for a serum level of ___

A

2-4wks after acute attack
low and increase
<0.3 mmol/l

25
Q

Ix for gout

A

PV CRP and ESR ^
WBC may be ^
xray
joint aspiration and bifringence

26
Q

pseudogout:
age:
ass. with __
affects ___ so ++_ joints

A

elderly
OA
fibrocartilage - knee, wrist, ankle

27
Q

pseudogout is associated with (12)

A 
OA
hyperPT
familial hypocalciuric hypercalcaemia
haemochromatosis
haemosiderosis
hypophostphatasia/magnesaemia/thyroid
neuropathic joints
trauma
amyloidosis
gout
28
Q

treatment of pseudogout =

A

NSAIDs (colchicine if contraind)
steroids
rehydration

29
Q

Milwaukee shoulder =

A

hydroxyapatite (crystals of it deposited in and around joint)

30
Q

Hydroxypatite = __+__ deterioration, gender, age, ___ stain shows __ clumps

A 
acute and rapid
F
50-60yo
alizarin
red
31
Q

bone scan can show the ____ in seronegative arthritis

A

increased vascularity accompanying synovitis

MSKJaz (28 decks)

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