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Y2 Musculoskeletal > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

describe the healing potential of articular cartilage

A

poor

unable to regenerate if damage

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2
Q

what cartilage covers the bones in synovial joints?

A

hyaline cartilage

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3
Q

what is hyaline cartilage made of?

A

water
collagen
proteoglycans
chondrocytes

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4
Q

what is primary osteoarthritis?

A

osteoarthritis when no cause is identified

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5
Q

what is involved in the conservative management of osteoarthritis?

A

NSAIDs
weight loss if needed
physiotherapy
steroid injections

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6
Q

how many steroid injections can be given for OA?

A

up to three per year

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7
Q

what is the risk of steroid injections in OA?

A

can cause further damage and accelerate the OA

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8
Q

what is TKR?

A

total knee replacement

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9
Q

when should TKR be considered for knee osteoarthritis?

A

moderate OA on X-ray

severe pain, not controlled conservatively

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10
Q

what characterises OA?

A

cartilage loss and accompanying periarticular change

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11
Q

what disease is often called “wear and tear” of the joints?

A

osteoarthritis

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12
Q

what joints can be affected by OA?

A

any synovial joint

most common = knees, hips and hands

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13
Q

what are the three main pathological changes in OA?

A

localised loss of hyaline cartilage

remodelling of adjacent bone

new bone formation at joints

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14
Q

what are the two main types of OA?

A

localised

generalised

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15
Q

what is localised OA?

A

osteoarthritis affecting one joint area

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16
Q

what is generalised OA?

A

OA at either the spinal/hand joints and at least two other joint regions

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17
Q

what two characteristic features can be seen in OA of the hand?

A

heberden’s nodes

bouchard’s nodes

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18
Q

where are heberden’s nodes found?

A

DIP joints

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19
Q

where are bouchard’s nodes found?

A

PIP joints

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20
Q

what is the classical clinical presentation of OA?

A

pain
morning stiffness <30 mins
instability

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21
Q

describe the pain in OA

A

gets worse with joint use

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22
Q

name five features found on examination of OA

A 
joint line tenderness
crepitus 
bony swelling 
deformity 
limitation of motion
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23
Q

how is a diagnosis of OA made?

A

clinical suspicion

x-rays

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24
Q

what is seen on x-ray of OA?

A

Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts

25
Q

what are the two surgical options for OA?

A

joint replacement

arthroscopic surgeries to remove loose bodies

26
Q

what is deposited in the joints in gout?

A

monosodium urate crystals

27
Q

what is deposited in the joints in pseudogout?

A

calcium pyrophosphate crystals

28
Q

what is deposited in the joints in hydroxyapatite?

A

calcium phosphate

29
Q

which sex is more commonly affected by gout?

A

men

30
Q

what particular group of women is gout rare in and why?

A

before the menopause

oestrogen is protective

31
Q

what two main things can cause hyperuricaemia?

A

increased urate production

reduced urate excretion

32
Q

name four things that can increase urate production

A

enzyme defects
psoriasis
alcohol
high dietary purine intake

33
Q

name four things that can reduce urate excretion

A

chronic renal disease
volume depletion
hypothyroidism
diuretics

34
Q

describe the pattern of joint involvement in acute gout

A

usually a monoarthropathy

35
Q

what are some common affected sites in acute gout?

A

first MTPJ
ankle
knee

36
Q

what can uric acid levels be like in an acute attack of gout?

A

normal

37
Q

what is chronic gout often associated with?

A

diuretic use

38
Q

what are uric acid levels like in chronic gout?

A

high

39
Q

what skin feature is present in chronic gout?

A

gouty tophi

40
Q

what investigations are done for gout (4)?

A

serum uric acid
inflammatory markers
microscopy of synovial fluid
x-rays

41
Q

what will inflammatory markers be like in gout?

A

raised

42
Q

what three drugs are given for acute gout?

A

NSAIDs
colchicine
steroids

43
Q

what are five indications for prophylactic therapy of gout?

A 
two or more attacks in a year 
signs of chronic gout 
renal impairment 
heart failure - on diuretics 
chemotherapy with gout
44
Q

what is another name for pseudogout?

A

calcium pyrophosphate deposition disease (CPDD)

45
Q

in what group is pseudogout more common?

A

the elderly

46
Q

what is affected by pseudogout?

A

fibrocartilage

47
Q

name three joints commonly affected by pseudogout?

A

knees
wrists
ankles

48
Q

describe the appearance of calcium pyrophosphate crystals

A

envelope shaped

mildly positive birefringent

49
Q

what happens to inflammatory markers in pseudogout?

A

raised

50
Q

how is pseudogout managed?

A

NSAIDs
colchicine
steroids
hydration

51
Q

what group is most commonly affected by hydroxyapatite?

A

females aged 50-60

52
Q

how is hydroxyapatite managed?

A

NSAIDs
steroid injections
physio
arthroplasty

53
Q

what is soft tissue rheumatism?

A

a general term to describe pain caused by inflammation or damage to tissues near a joint

54
Q

what is the pain like in soft tissue rheumatism?

A

confined to one specific site

55
Q

what is the most common area for soft tissue rheumatism?

A

the shoulder

56
Q

who is more commonly affected by joint hypermobility syndrome?

A

females

57
Q

what are some rare causes of joint hypermobility syndrome?

A

marfan’s

ehler’s danlos

58
Q

when does joint hypermobility syndrome often present?

A

childhood

the third decade

59
Q

how is joint hypermobility syndrome diagnosed?

A

the modified beighton score

considered if patients have >4 out of 9

Y2 Musculoskeletal (37 decks)

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