OA and crystal arthropathies Flashcards
pathogenesis of OA:
___ lost, cytokine release (eg. 4) by chondrocytes,
___ cartilage and ___ formation
cartilage matrix
IL-1,TNFα, MMPs, prostaglandin
fibrillated
osteophyte
mechanical pain is worse __+__
on movement and at the end of day
hand signs of OA
squaring of the thumb
Heberdens (DIPJ)
Bouchards (PIPJ)
spine signs of OA
C spine pain and reduced movement
maybe nerve impingement
lumbar spine involvement may = spinal stenosis
knee signs of OA
osteophytes, effusion, crepitus
genu varum/valgus
Bakers cyst
risk factors for OA
>40 yo F occupation injury/abnormal biomechanics obesity comorbidities
Ix for OA
blood test (inflam markers usually normal) xray (osteophyte, lost joint space, subchondral sclerosis.., bony cysts)
Management of OA
physio
wt loss
podiatry +OT
analgesia - paracetamol, NSAIDs, capsaicin, tricyclics
possibly intra art steroids / replacement
monosodium urate crystal deposition => inflam =
gout
gout:
M:F
M>F
hyperuricaemia = serum levels ___
> 7mg/dl or 0.42mmol/l
risk of developing gout is proportional to degree of ___ but is not the same thing!
hyperuricaemia
overproduction causes of gout
genetic (Lysch-Nyhan, Von Gierke)
psoriasis, malig, haem and pernicious anaemia, bleeding, exercise, obesity, infection
foods high in purones - offal, red meat, shellfish
genetic disorder that is hypoxanthine guanine phosphoribosyltransferase deficiency
Lysch-Nyhan
glucose 6 phosphatase deficiency genetic disorder
Von Gierkes
underexcretion causes of gout
renal impairment starvation dehydration hypothyroid hyperPT alcohol drugs - levodopa, diuretics, cyclosporin A, pyrazinamide
gout is precipitated by ___ in ___ levels
acute changes in uric acid levels
presentation of gout =
red and hot, severely painful monoarthritis for <=2wks
usually 1st MTP > ankle >knee>upper limb >spine
chronic polyarticular gout is usually after ___ acute for more than ___, have ___ and often __ associated
recurrent >10yrs
tophi
diuretic
gold standard Ix for gout
joint aspiration and bifringence microscopy
management of acute gout =
NSAIDs or colchicine (if contraind to NSAIDs)
steroids
analgesia
lifestyle management of gout
decrease alcohol intake, purine high foods, weight
avoid fructose high drinks
2l fluids per day at least
prophylaxis for gout is given if ____
Rx =
> 2 attacks, tophi, xray erosions, renal stones
urate lowering - allopurinol/febuxostat
start urate lowering drugs eg allopurinol ____
start on a __ dose and ___
aim for a serum level of ___
2-4wks after acute attack
low and increase
<0.3 mmol/l
Ix for gout
PV CRP and ESR ^
WBC may be ^
xray
joint aspiration and bifringence
pseudogout:
age:
ass. with __
affects ___ so ++_ joints
elderly
OA
fibrocartilage - knee, wrist, ankle
pseudogout is associated with (12)
OA hyperPT familial hypocalciuric hypercalcaemia haemochromatosis haemosiderosis hypophostphatasia/magnesaemia/thyroid neuropathic joints trauma amyloidosis gout
treatment of pseudogout =
NSAIDs (colchicine if contraind)
steroids
rehydration
Milwaukee shoulder =
hydroxyapatite (crystals of it deposited in and around joint)
Hydroxypatite = __+__ deterioration, gender, age, ___ stain shows __ clumps
acute and rapid F 50-60yo alizarin red
bone scan can show the ____ in seronegative arthritis
increased vascularity accompanying synovitis
