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The Musculoskeletal System > Osteoarthritis and Crystal Arthropathies > Flashcards

Osteoarthritis and Crystal Arthropathies Flashcards

1
Q

What is the most common form of arthritis?

A

Osteoarthritis

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2
Q

Osteoarthritis is characterised by which two main physical changes?

A
  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)

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3
Q

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

A

Osteophytes

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4
Q

What type of onset is associated with osteoarthritis?

A

Gradual

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5
Q

In osteoarthritis, when is the pain worse?

A
  • During activity
  • In the morning with stiffness lasting < 30 mins
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6
Q

How long will stiffness last in the morning with osteoarthritis?

A

< 30 minutes

(> 30 minutes is usually associated with rheumatoid)

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7
Q

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

A
  1. Heberden’s nodes
  2. Bouchard’s nodes
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8
Q

Heberden’s nodes affect which joints?

A

DIP

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9
Q

Bouchard’s nodes affect which joints?

A

PIP

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10
Q

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

A

Genu varum

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

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11
Q

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

A

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

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12
Q

Why does osteoarthritis within the spine often cause sciatica?

A

Osteophytes may impinge on nerve roots

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13
Q

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

A

Mid-late 40s

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14
Q

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

A

They are usually normal

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15
Q

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

A
  • Joint space narrowing
  • Subchondral sclerosis
  • Bony cysts
  • Osteophytes
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16
Q

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

A

Rheumatoid arthritis

17
Q

Which type of arthritis most commonly affects the carpometacarpal joints?

A

Osteoarthritis

18
Q

What is the pharmacological management for osteoarthritis?

A
  • Analgesia
  • NSAIDS
  • Pain modulators e.g. amitriptyline, gabapentin
  • Intra-articular steroids (with lignocaine) for short term relief
19
Q

What is the non-pharmacological treatment for osteoarthritis?

A
  • Education
  • Physiotherapy
  • Weight loss
  • Footwear
  • Walking aids
20
Q

When is arthroplasty considered for a patient with osteoarthritis?

A

When there is constant pain and limited movement

21
Q

Gout is a type of what?

A

Inflammatory arthritis

22
Q

Gout is caused due to a deposition of what?

A

Monosodium urate crystal

(needle-shaped birefringent crystals)

23
Q

What level of pain is associated with gout?

A

Very severe

24
Q

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

A
  • High protein intake
  • High cellular breakdown
25
Q

How is uric acid produced in the body?

A
  • 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
26
Q

Serum urate is classed as being high when it exceeds which level?

A

>7mg/dL

27
Q

When is the best time to measure serum urate?

A

2 weeks following an attack

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

28
Q

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

A

There is high cell breakdown or turnover

29
Q

Acute gout has what type of onset?

A

Rapid

(often overnight)

30
Q

What is the most common joint affected by gout?

A

1st MTP joint

31
Q

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

A

Septic arthritis

32
Q

What is the gold standard investigation for gout?

A

Joint aspiration

  • Allows for differentiation between gout and pseudogout via microscopy
  • Can rule out infective arthritis
33
Q

How is gout acutely managed?

A
  • NSAIDs
  • Colchine (anti-inflammatory)
  • Corticosteroids (oral, IM or IA)
  • Analgesia (paracetamol, tramadol etc)
34
Q

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

A
  • Alcohol
  • Fizzy drinks (with high fructose corn syrup)
35
Q

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

A
  • Allopurinol
  • Febuxostat

Aim for serum urate <0.3mmol/l

36
Q

Pseudogout is caused by a deposition of what?

A

Calcium pyrophosphate dihydrate crystals

37
Q

Pseudogout is related to which other condition?

A

Osteoarthritis

38
Q

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

A

Hydroxyapatite

The Musculoskeletal System (58 decks)

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