Osteoarthritis and Crystal Arthropathies Flashcards
What is the most common form of arthritis?
Osteoarthritis
Osteoarthritis is characterised by which two main physical changes?
- Gradual thinning of cartilage
- Loss of joint space
(there is also formation of bony spurs (osteophytes), thickening of bone (subchondral sclerosis) and fibrillation of the joint articulation)
What is the term given to the bony spurs formed in osteoarthritis?
Osteophytes
What type of onset is associated with osteoarthritis?
Gradual
In osteoarthritis, when is the pain worse?
- During activity
- In the morning with stiffness lasting < 30 mins
How long will stiffness last in the morning with osteoarthritis?
< 30 minutes
(> 30 minutes is usually associated with rheumatoid)
Within the hands which two types of nodes can be formed as a result of osteoarthritis?
- Heberden’s nodes
- Bouchard’s nodes
Heberden’s nodes affect which joints?
DIP
Bouchard’s nodes affect which joints?
PIP
The outward bowing at the knee, causing the lower limb to be angled inward, experienced during osteoarthritis is called what?
Genu varum
(varus deformities = inward (medial) angulation, valgus deformities = outward (lateral) angulation)
What is a Baker’s cyst and which condition is it associated with?
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
Why does osteoarthritis within the spine often cause sciatica?
Osteophytes may impinge on nerve roots
Osteoarthritis most commonly begins to affect people in which age bracket?
Mid-late 40s
In osteoarthritis, what changes may be seen in inflammatory markers?
They are usually normal
Upon X-ray, which changes can be seen for osteoarthritis?
- Joint space narrowing
- Subchondral sclerosis
- Bony cysts
- Osteophytes
Which type of arthritis most commonly affects the metacarpal-phalangeal joints?
Rheumatoid arthritis
Which type of arthritis most commonly affects the carpometacarpal joints?
Osteoarthritis
What is the pharmacological management for osteoarthritis?
- Analgesia
- NSAIDS
- Pain modulators e.g. amitriptyline, gabapentin
- Intra-articular steroids (with lignocaine) for short term relief
What is the non-pharmacological treatment for osteoarthritis?
- Education
- Physiotherapy
- Weight loss
- Footwear
- Walking aids
When is arthroplasty considered for a patient with osteoarthritis?
When there is constant pain and limited movement
Gout is a type of what?
Inflammatory arthritis
Gout is caused due to a deposition of what?
Monosodium urate crystal
(needle-shaped birefringent crystals)
What level of pain is associated with gout?
Very severe
Gout is associated (or partially caused) by two main things, what are they?
- High protein intake
- High cellular breakdown
How is uric acid produced in the body?
- 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
Serum urate is classed as being high when it exceeds which level?
>7mg/dL
When is the best time to measure serum urate?
2 weeks following an attack
(during an attack serum urate is lowered due to the precipitation of urate crystals in the body)
Why may cancer patients or psoriasis patients have an increased risk of gout?
There is high cell breakdown or turnover
Acute gout has what type of onset?
Rapid
(often overnight)
What is the most common joint affected by gout?
1st MTP joint
If a patient presented with what appeared to be gout, but had a fever or recent wound, what would be a worrying differential?
Septic arthritis
What is the gold standard investigation for gout?
Joint aspiration
- Allows for differentiation between gout and pseudogout via microscopy
- Can rule out infective arthritis
How is gout acutely managed?
- NSAIDs
- Colchine (anti-inflammatory)
- Corticosteroids (oral, IM or IA)
- Analgesia (paracetamol, tramadol etc)
Which types of drinks should be avoided in people susceptible to gout?
- Alcohol
- Fizzy drinks (with high fructose corn syrup)
Which urate lowering therapies can be given to people with gout?
- Allopurinol
- Febuxostat
Aim for serum urate <0.3mmol/l
Pseudogout is caused by a deposition of what?
Calcium pyrophosphate dihydrate crystals
Pseudogout is related to which other condition?
Osteoarthritis
Deposition of what can cause adhesive capsulitis or “frozen shoulder”?
Hydroxyapatite
