Osteoarthritis Flashcards
describe the healing potential of articular cartilage
poor
unable to regenerate if damage
what cartilage covers the bones in synovial joints?
hyaline cartilage
what is hyaline cartilage made of?
water
collagen
proteoglycans
chondrocytes
what is primary osteoarthritis?
osteoarthritis when no cause is identified
what is involved in the conservative management of osteoarthritis?
NSAIDs
weight loss if needed
physiotherapy
steroid injections
how many steroid injections can be given for OA?
up to three per year
what is the risk of steroid injections in OA?
can cause further damage and accelerate the OA
what is TKR?
total knee replacement
when should TKR be considered for knee osteoarthritis?
moderate OA on X-ray
severe pain, not controlled conservatively
what characterises OA?
cartilage loss and accompanying periarticular change
what disease is often called “wear and tear” of the joints?
osteoarthritis
what joints can be affected by OA?
any synovial joint
most common = knees, hips and hands
what are the three main pathological changes in OA?
localised loss of hyaline cartilage
remodelling of adjacent bone
new bone formation at joints
what are the two main types of OA?
localised
generalised
what is localised OA?
osteoarthritis affecting one joint area
what is generalised OA?
OA at either the spinal/hand joints and at least two other joint regions
what two characteristic features can be seen in OA of the hand?
heberden’s nodes
bouchard’s nodes
where are heberden’s nodes found?
DIP joints
where are bouchard’s nodes found?
PIP joints
what is the classical clinical presentation of OA?
pain
morning stiffness <30 mins
instability
describe the pain in OA
gets worse with joint use
name five features found on examination of OA
joint line tenderness crepitus bony swelling deformity limitation of motion
how is a diagnosis of OA made?
clinical suspicion
x-rays
what is seen on x-ray of OA?
Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts
what are the two surgical options for OA?
joint replacement
arthroscopic surgeries to remove loose bodies
what is deposited in the joints in gout?
monosodium urate crystals
what is deposited in the joints in pseudogout?
calcium pyrophosphate crystals
what is deposited in the joints in hydroxyapatite?
calcium phosphate
which sex is more commonly affected by gout?
men
what particular group of women is gout rare in and why?
before the menopause
oestrogen is protective
what two main things can cause hyperuricaemia?
increased urate production
reduced urate excretion
name four things that can increase urate production
enzyme defects
psoriasis
alcohol
high dietary purine intake
name four things that can reduce urate excretion
chronic renal disease
volume depletion
hypothyroidism
diuretics
describe the pattern of joint involvement in acute gout
usually a monoarthropathy
what are some common affected sites in acute gout?
first MTPJ
ankle
knee
what can uric acid levels be like in an acute attack of gout?
normal
what is chronic gout often associated with?
diuretic use
what are uric acid levels like in chronic gout?
high
what skin feature is present in chronic gout?
gouty tophi
what investigations are done for gout (4)?
serum uric acid
inflammatory markers
microscopy of synovial fluid
x-rays
what will inflammatory markers be like in gout?
raised
what three drugs are given for acute gout?
NSAIDs
colchicine
steroids
what are five indications for prophylactic therapy of gout?
two or more attacks in a year signs of chronic gout renal impairment heart failure - on diuretics chemotherapy with gout
what is another name for pseudogout?
calcium pyrophosphate deposition disease (CPDD)
in what group is pseudogout more common?
the elderly
what is affected by pseudogout?
fibrocartilage
name three joints commonly affected by pseudogout?
knees
wrists
ankles
describe the appearance of calcium pyrophosphate crystals
envelope shaped
mildly positive birefringent
what happens to inflammatory markers in pseudogout?
raised
how is pseudogout managed?
NSAIDs
colchicine
steroids
hydration
what group is most commonly affected by hydroxyapatite?
females aged 50-60
how is hydroxyapatite managed?
NSAIDs
steroid injections
physio
arthroplasty
what is soft tissue rheumatism?
a general term to describe pain caused by inflammation or damage to tissues near a joint
what is the pain like in soft tissue rheumatism?
confined to one specific site
what is the most common area for soft tissue rheumatism?
the shoulder
who is more commonly affected by joint hypermobility syndrome?
females
what are some rare causes of joint hypermobility syndrome?
marfan’s
ehler’s danlos
when does joint hypermobility syndrome often present?
childhood
the third decade
how is joint hypermobility syndrome diagnosed?
the modified beighton score
considered if patients have >4 out of 9
