OA/gout/fibromyalgia

Question 1

Investigation result in OA

Answer 1

No blood markers or inflamm markers raised

Radiological - Loss of joint space, Osteophytes, Subchondrial Sclerosis, Subchondral cyts

Question 2

Pathology of OA

Answer 2

There are focal areas of destruction of articular cartilage (fibrillation and erosion) - loss of joint space
Hypertriohy of the subchondral bone - subchondral sclerosis, joint margin osteophytes formation, synovial metaplasia, -cysts

Question 3

Mx OA

Answer 3

Reassure, education, physio, exercise, weightloss, OT
Med - analgesia, anti inflamm, steroid injection
Surg.- joint replacement

Question 4

Pathogenesis of gout

Answer 4

Over produce - high cell turnover states such as tx for lymphoma 
Under excrete - inherited
Diet - high purine diet 
Drugs - thiazides diuretics 
Alcohol 
FHx

Question 5

Symp and signs of gout

Answer 5

Hot, red painful joint sudden
Tophi elbow
MCP 1st commonly affected - Podagra

Question 6

Investigation and findings

Answer 6

No inflamm makers - ESR, CRP

Joint/nodule aspiration - under polarised light - -ve birefringent needle shaped crystals

Question 7

Mx gout

Answer 7

Mx risk factors - alcohol reduce, diet changes
Acute episode - NSAIDS, colchicine - reduced neutrophil migration and degranulation
Intrarticular injection steroids
Maintenance if have 3 or more episodes a year
Allopurinol
Febuxstat

Question 8

What is pseudogout

Answer 8

Calcium pyrophosphate dehydrate arthropathy
Chondrocalcinosis of joints
This causes an inflammatory reaction

Question 9

What does aspiration of fluid in pseudo gout show

Answer 9

Polarised light +ve birefringent rhomboid shaped crystal

Question 10

What is the main differential diagnosis if monoarthritis presents

Answer 10

Sepsis - single inflamed joint

Need to aspirate and gram stain and culture whilst also looking for crystals

Question 11

What are the symptoms of fibromyalgia

Answer 11

Constant pain and stiffness in the muscles and joint 
Severe fatigue 
parasthesia, or memory
No other features systemically 
No PMH FHx of any rhem
Significant stressors in life

Question 12

Where are the typical points affected by fibromyalgia

Answer 12

18 
Knee x2
Lateral epicondyle x2
Steroclavicular 2
Neck x2 
Trochanteric bursa x2 
Occiput x2 
Trapezius x4
Sacroiliac x2

Question 13

Diagnostic pain points no.

Answer 13

11/18

Question 14

Ix fibromyalgia

Answer 14

Clinical diagnosis
Tests are done to rule anything out
It is a diagnosis of exclusion

Question 15

Tx fibromyalgia

Answer 15

Con - relaxation techniques
Exercise, self care
Med - antidepressant, analgesia, anti-seizure

Question 16

What is fibromyalgia not which it can get confused with

Answer 16

Polymyalgia rheumatica
It is inflammatory
Proximal pelvic and shoulder muscles
Inc acute phase reaction