Osteoarthritis and Crystal Arthropathies

Question 1

What is the most common form of arthritis?

Answer 1

Osteoarthritis

Question 2

Osteoarthritis is characterised by which two main physical changes?

Answer 2

1. Gradual thinning of cartilage
2. Loss of joint space

(there is also formation of bony spurs (osteophytes), thickening of bone (subchondral sclerosis) and fibrillation of the joint articulation)

Question 3

What is the term given to the bony spurs formed in osteoarthritis?

Answer 3

Osteophytes

Question 4

What type of onset is associated with osteoarthritis?

Answer 4

Gradual

Question 5

In osteoarthritis, when is the pain worse?

Answer 5

• During activity
• In the morning with stiffness lasting < 30 mins

Question 6

How long will stiffness last in the morning with osteoarthritis?

Answer 6

< 30 minutes

(> 30 minutes is usually associated with rheumatoid)

Question 7

Within the hands which two types of nodes can be formed as a result of osteoarthritis?

Answer 7

1. Heberden’s nodes
2. Bouchard’s nodes

Question 8

Heberden’s nodes affect which joints?

Answer 8

DIP

Question 9

Bouchard’s nodes affect which joints?

Answer 9

PIP

Question 10

The outward bowing at the knee, causing the lower limb to be angled inward, experienced during osteoarthritis is called what?

Answer 10

Genu varum

(varus deformities = inward (medial) angulation, valgus deformities = outward (lateral) angulation)

Question 11

What is a Baker’s cyst and which condition is it associated with?

Answer 11

It is swelling of the semimembranosus and (much more rarely) the synovial bursa of the knee joint.

It is a false cyst (as it is often still attached to the synovial bursa and not independent) that is present at the popliteal fossa

It is associated with osteoarthritis

Question 12

Why does osteoarthritis within the spine often cause sciatica?

Answer 12

Osteophytes may impinge on nerve roots

Question 13

Osteoarthritis most commonly begins to affect people in which age bracket?

Answer 13

Mid-late 40s

Question 14

In osteoarthritis, what changes may be seen in inflammatory markers?

Answer 14

They are usually normal

Question 15

Upon X-ray, which changes can be seen for osteoarthritis?

Answer 15

• Joint space narrowing
• Subchondral sclerosis
• Bony cysts
• Osteophytes

Question 16

Which type of arthritis most commonly affects the metacarpal-phalangeal joints?

Answer 16

Rheumatoid arthritis

Question 17

Which type of arthritis most commonly affects the carpometacarpal joints?

Answer 17

Osteoarthritis

Question 18

What is the pharmacological management for osteoarthritis?

Answer 18

• Analgesia
• NSAIDS
• Pain modulators e.g. amitriptyline, gabapentin
• Intra-articular steroids (with lignocaine) for short term relief

Question 19

What is the non-pharmacological treatment for osteoarthritis?

Answer 19

• Education
• Physiotherapy
• Weight loss
• Footwear
• Walking aids

Question 20

When is arthroplasty considered for a patient with osteoarthritis?

Answer 20

When there is constant pain and limited movement

Question 21

Gout is a type of what?

Answer 21

Inflammatory arthritis

Question 22

Gout is caused due to a deposition of what?

Answer 22

Monosodium urate crystal

(needle-shaped birefringent crystals)

Question 23

What level of pain is associated with gout?

Answer 23

Very severe

Question 24

Gout is associated (or partially caused) by two main things, what are they?

Answer 24

• High protein intake
• High cellular breakdown

Question 25

How is uric acid produced in the body?

Answer 25

• Protein is broken down to for purines
• Purines are metabolised to hypoxanthines
• Hypoxanthies are metabolised to xanthines
• Xanthines are metablised to plasma urate
• Plasma urate is metabolised to urine uric acid

Question 26

When is the best time to measure serum urate?

Answer 26

2 weeks following an attack

(during an attack serum urate is lowered due to the precipitation of urate crystals in the body)

Question 27

Why may cancer patients or psoriasis patients have an increased risk of gout?

Answer 27

There is high cell breakdown or turnover

Question 28

Acute gout has what type of onset?

Answer 28

Rapid

(often overnight)

Question 29

What is the most common joint affected by gout?

Answer 29

1st MTP joint

Question 30

If a patient presented with what appeared to be gout, but had a fever or recent wound, what would be a worrying differential?

Answer 30

Septic arthritis

Question 31

What is the gold standard investigation for gout?

Answer 31

Joint aspiration

• Allows for differentiation between gout and pseudogout via microscopy
• Can rule out infective arthritis

Question 32

How is gout acutely managed?

Answer 32

• NSAIDs
• Colchine (anti-inflammatory)
• Corticosteroids (oral, IM or IA)
• Analgesia (paracetamol, tramadol etc)

Question 33

Which types of drinks should be avoided in people susceptible to gout?

Answer 33

• Alcohol
• Fizzy drinks (with high fructose corn syrup)

Question 34

Which urate lowering therapies can be given to people with gout?

Answer 34

• Allopurinol
• Febuxostat

Aim for serum urate <0.3mmol/l

Question 35

Pseudogout is caused by a deposition of what?

Answer 35

Calcium pyrophosphate dihydrate crystals

Question 36

Pseudogout is related to which other condition?

Answer 36

Osteoarthritis

Question 37

Deposition of what can cause adhesive capsulitis or “frozen shoulder”?

Answer 37

Hydroxyapatite