Osteoarthritis and crystal arthropathies Flashcards
What is the pathogenesis of osteoarthritis?
- loss of cartilage matrix
- cytokine release (IL-1, TNF)
- release of metalloproteinases and prostaglands by chondrocytes
- Fibrillation of cartilage surface and osteophyte formation
What are the symptoms of osteoarthritis?
- Gradual onset: months-years
- mechanical pain (on activity)
- crepitus (creaking, grinding)
- stiffness
- bony swelling
- effusions and soft tissue swelling
What are Heberdens nodes?
Bony enlargement in the distal interphalangeal joints
What are Bouchards nodes?
Bony enlargement in Proximal interphalangeal joints
What are the osteoarthritis features on X-ray?
LOSS Loss of joint space Osteophytes Sclerosis (subchondral) Subchondral cysts
What are the main joints affected by osteoarthritis?
Distal interphalangeal
Carpometacarpal
What is the pharmacological treatment of osteoarthritis?
-Analgesia - paracetamol
NSAIDs
-Pain modulators - amitriptyline, gabapentin
-Intra-articular steroids
What are the possible causes of excessive purine breakdown, resulting in urate accumulation?
- crash diet
- chemotherapy in cancer
- high protein dietary intake
- psoriasis
- infection
- haemolytic and pernicious anaemia
- bleeding
What is the most common site affected by gout?
1st Metatarsophalyngeal joint
-podagra
Inflammatory markers - CRP, PV/ESR - are ____ in gout.
raised
What is the gold standard diagnostic test for gout?
Microscopy of joint aspirate
What is the management of an acute gout attack?
NSAIDs or Colchicine or Corticosteroids
What urate lowering therapy may be used in gout? What is the target serum urate?
Allopurinol
target urate: <0.30 mmol/L
What conidtion is pseudogout associated with?
osteoarthritis
What deposits form in pseudogout?
How does it differ on microscopy from urate crystals?
Calcium Pyrophosphate Deposits
Rhomboid crystals
