Osteoarthritis Flashcards
what is osteoarthritis
a chronic disease characterised by cartilage loss and accompanying periarticular change
key pathological changes of OA
localised loss of hyaline cartilage and remodelling of adjacent bone with new bone formation at joint margins
what triggers the need to repair
a variety of joint traumas
risk factors for OA
genetic factors ageing female sex obesity joint injury occupational usage reduced muscle strength joint laxity joint malignancy
what joints does localised OA affect
hips, knees, finger, facet joints of lower cervical and lower lumbar spines
what joints does generalised OA affect
defined as OA at either the spinal or hand joints and in at least 2 other regions
what is the clinical marker for generalised osteoarthritis
the presence of multiple heberden’s nodes
what are heberdens nodes
boney swellings at fingers
what type of joints are affected by OA
synovial
OA presentation
pain - worse with joint use morning stiffness lasting less than 30 mins inactivity gelling instability poor grip in thumb OA
examination features of OA
- joint line tenderness
- crepitus
- bony swelling
- deformity
- limitation of motion
presentation of cervical spine OA
pain and restriction of movement
occipital headaches may occur
presentation of lumbar spine oa
osteophytes can cause spinal stenosis if they encroach on the spinal canal
diagnosis of OA
clinical history
plain X-rays
MRI scans
ultrasound scans
what would be seen on X-ray in OA
marginal osteophytes
joint space narrowing
subchondral sclerosis
subchondral cysts
management of osteoarthritis
education lifestyle management physiotherapy occupational therapy analgesia local intra-articular steroid injections
surgical management for OA
joint replacements
arthroscopic surgery to remove loose bodies
what are crystal arthropathies
they are a diverse group of disorders characterised by the deposition of various minerals in joints and soft tissues leading to inflammation
what is gout
a potentially disabling and erosive inflammatory arthritis caused by the deposition of monosodium urate crystals into joints and soft tissues
causes of hyperuricaemia
increased urate production
reduced urate excretion
what can cause increased urate production
- inherited enzyme defects
- myeloproliferative/lymphoproliferative disorders
- psoriasis
- haemolytic disorders
- alcohol
- high dietary purine intake
causes of reduced urate excretion
- chronic renal impairment
- volume depletion
- hypothyroidism
- diuretics
- cytotoxics
presentation of acute gout
MTP joint - ankle, knee
settles in about 10 days without treatment - 3 days with treatment
abrupt onset, often overnight
chronic tophaceous gout
chronic joint inflammation often diuretic associated high serum uric acid tophi may get acute attacks
gout investigations
serum uric acid raised raised inflammatory markers polarised microscopy of synovial fluid renal impairment x-rays
how do you treat acute gout
NSAIDs
colchicine
steroids
preventative measures for gout
- Xanthine oxidase inhibitors - allopurinol, febuxostat
- uricosuric drugs - sulfinpyrazone, probenecid, benzbromarone
- IL-1 inhibitors - canakinumab, start 2 weeks after acute attack, requires cover with NSAIDs
what are the indications for prophylactic therapy
1) two or more attacks of gout in year despite lifestyle change
2) presence of gouty tophi or signs of chronic gouty arthritis
3) uric acid calculi
4) chronic renal impairment
5) heart failure where unable to stop diuretics
6) chemotherapy patients who develop gout
what is the target uric acid level for gout
300-360umol/L
what does calcium pyrophosphate deposition disease affect
fibrocartilage
-knees, wrists, ankles
causes of CPPD
ageing osteoarthritis hyperparathyroidims gout trauma familial hypocalciuric hypercalcaemia hemochromatosis hypomagnesemia hypothyroidism amyloidosis
treatment for CPPD
NSAIDs
colchicine
steroids
rehydration
what is hydroxyapatite
hydroxyapatite crystal deposition in or around the joint
release of collagenases, serine proteases and IL-1
treatment for hydroxyapatite
NSAIDS
intra-articular steroid injection
physiotherapy
partial or total arthroplasty
what is soft tissue rheumatism
general term to describe pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerve near a joint rather than bone or cartilage
what is the commonest area for soft tissue pain
the shoulder
investigations for soft tissue problems
X-ray - calcific tendonitis
MRI if fails to settle
identify precipitating factors
management for soft tissue problems
pain control rest and ice compressions PT steroid injections surgery
symptoms of joint hypermobility
join pain especially after exercise joint stiffness foot and ankle pain neck and backache frequent sprains and dislocations thin stretchy skin
what does the modified beighton score measure
hypermobility
treatment for hypermobility
- education
- physiotherapy
- analgesia
- surgery not recommended
