Osteoarthritis and crystal arthropathies Flashcards
What differences are there in a normal synovial joint and an osteoarthritic joint?
Inflammation of synovial membrane, articular cartilage failure, loss of joint space
What is the pathogenesis of osteoarthritis?
Loss of cartilaginous matrix, release of IL1 and TNF cytokines which results in fibrillation of the cartilage surface.
What are the two types of ostearthritis?
Idiopathic
Secondary
Where does idiopathic osteoarthritis most commonly affect?
Hands, feet, knee, hip, spine.
What can cause secondary osteoarthritis?
Previous injury,
RA
Acromegary
What are the risk factors for developing osteoarthritis?
Older, Female, Obesity, Sports, Previous injury
What are the symptoms of osteoarthritis?
Pain worse on activity and relieved by rest
Stiffness in the morning.
On examination, what do you expect to find in a osteoarthritis positive patient?
Joint tenderness
Joint effusion
Crepitus
Bony enlargements
Where does osteoarthritis tend to affect?
Hip, knee, MTP joints in foot, cervical and lumbar spine.
Big toe.
What are enlargements at the distal interphalangeal joints called?
Heberdens nodes
What are enlargements at the proximal interphalangeal joints called?
Bouchards nodes
How is osteoarthritis diagnosed?
On x-ray:
loss of joint space
subchondral sclerosis
subchondral cysts
What blood findings differentiate RA from osteoarthritis?
RA has positive rheumatoid factor and a positive anti-CCP Ab.
Osteoarthritis has normal CRP and ESR
What is the non-pharmalogical management process of osteoarthritis?
Physiotherapy
weight loss
Exercise
Trainers
What drugs can be used to treat osteoarthritis?
Analgesia
NSAIDs- need to balance risk
Amitriptyline, gabapentin
What intra-articular injections can be given?
Steroids- main one
Hyaluronic acid
What surgical procedures can be given as management for osteoporosis?
Arthroscopic washout (not routine) Joint replacement.
What would you expect to find within the synovial capsule?
Synovial fluid
What is gout?
Inflammation in the joint, triggered by uric acid crystals.
Which sex is gout more common in?
Male
What is uric acid?
Uric acid is the final compound in breakdown of DNA metabolism.
What factors cause hyperuricaemia?
Alcohol High dietary purine intake- red meat, seafood Psoriasis Haemolytic disorders Hypothyroidism Diuretics
Where does gout normally affect?
1st metatarsal phalangeal joint- big toe
Then the ankle
then the knee
How long does it take for gout to resolve itself?
10 days
Does gout have an acute or chronic onset?
Sudden.
Usually over night.
What affect does osteoporosis have on osteoarthritis?
Seems to have a protective effect.
What affect does rheumatoid arthritis have on osteoarthritis?
Can contribute to osteoarthritis.
Osteoarthritis CAN NOT cause RA.
What is chronic tophaeceous gout?
Chronic joint inflammation which can have acute attacks.
Often diuretic associated
Has high serum uric acid.
What investigations would you do if you suspected gout?
Serum uric acid (may be normal!)
CRP, ESR
Joint aspiration
x-ray
What is the treatment for an acute attack of gout?
NSAIDs
Colchicine
Steroids.
What is the prophylactic treatment of gout?
Allopurinol
Febuxostat
Need to cover with NSAIDs or colchine.
What is important to note in giving febuxostat?
Needs to have liver function tests every 6 months
Rare analphylaxis and Steven-Johnson’s syndrome
Caution in transplant patients
What is calcium pyrophosphate deposition disease?
Pseudogout.
Where does calcium pyrophosphate deposition disease affect?
Affects fibrocartilage i.e. knees, wrists, ankles.
How would you treat calcium pyrophosphate deposition disease?
NSAIDs
Colchine
Steroids
rehydration
What investigations would you do if you suspected osteoarthritis?
No lab tests.
History, exam and x`-ray.
At what mmol/L does uric acid become insoluble?
0.42
What is Milwaukee shoulder?
Hydroxypatite crystal deposition around the joint.
Who is Milwaukee shoulder most common in?
Females 50-60
What treatment can be given for Milwaukee shoulder?
NSAIDs
Intra-articular steroids
Physio
What is soft tissue rheumatism?
General term that describes pain that is caused by damage to ligaments, tendons, muscle etc.
Where would a soft tissue rheumatism affect?
In a localised, specific site. If not `then consider fibromyalgia.
On x-ray in osteoarthritic patient, what are you expecting to see?
L - loss of joint space
O - osteophytes
S - sclerosis (whiter)
S - subchondral cysts
