Osteoarthritis and Crystal Arthropathies Flashcards
most common form of arthritis?
osteoarthritis
pathogenic effects of osteoarthritis on bone?
formation of osteocytes
loss of joint space
thinning of cartilage
bony swelling
does cartilage grow back?
no
how does cartilage thin?
loses its matrix
why are osteocytes present?
in an attempt to repair broken down cartilage
what kind of pain does osteoarthritis present with?
mechanical pain i.e worse on activity, worse at end of day
is osteoarthritic pain relieved by rest or exercise?
rest
how long are joints typically stiff for?
<30 mins
most common areas affected by osteoarthritis?
neck lower back ends of fingers base of thumb base of big toe hips knees
which part of the hands are most affected by osteoarthritis?
DIP
PIP
1st CMC
base of thumb
what are bony enlargements affecting the DIP joint called?
heberdens nodes
what are bony enlargements affected PIP joint called?
bouchards nodes
manifestations of osteoarthritis on the leg?
bakers cyst
genu varus
where can hip pain typically be felt?
groin
hip
radiating knee
where can hip pain be a referred pain from?
lower back
what is a bakers cyst?
lump in popliteal fossa from drained effusion from joint
risk factors for OA
age>40 female genetic job involving strain previous injury obesity MSK comorbs
what joints does RA tend to affect?
MCP
PIP joints
how do the joint characteristics of RA differ from OA
RA= soft, warm, tender OA= cold, hard, bony
what would be the result of ESR and CRP for OA
normal
what would the anti CCP antibody result be for OA
negative
what would the result of ESR and CRP be for RA
raised
what would the anti CCP antibody result be for RA
positive
is the treatment for OA curative?
no
treatment for OA?
analgesics
NSAIDs (careful)
pain modulators eg amitriptyline/gabapentin
steroids short term (intraarticular)
2 main crystal arthropathy conditions?
gout
pseudogout
what salt deposition goes on in gout?
monosodium urate crystals
is gout more common in women or men
men
what can increase purine production and thus increase uric acid?
red meats shellfish legumes protein supplements genetics underexcretion rapid cell breakdown eg psoriasis
what value indicates hyperuricaemia?
> 7mg/dL
what things would cause underexcretion of uric acid?
starvation dehydration hypothyroidism hyperparathyroidism diuretics renal insufficiency
best time to measure serum urate in a suspected gout patient
2 weeks after acute attack
what is the first metacarpal phalangeal joint?
big toe
clinical presentation of gout
unilateral hot, red, swollen area that is very painful on either big toe, ankle, knee, upper limb, spine
differential diagnoses for gout
septic arthritis
trauma
psoriatic arthritis
what is chronic polyarticular gout?
chronic joint inflammation as a result of recurrent gout attacks over 10+ years
investigations for gout
joint aspirate
inflammatory markers
x ray
buzzword for gout findings on joint aspirate
needle shaped crystals
negative birefringence
treatment for gout
NSAIDs
colchicine
corticosteroids
analgesia
cause of pseudogout?
calcification of cartilage
who gets pseudogout?
elderly
most common areas affected by pseudogout
knees, wrist, ankles
how does allopurinol help in gout
prevents uric acid production
risk factors for pseudogout
age trauma gout hypercalcaemia hypothyroidism
treatment for pseudogout?
NSAIDs
colchicine
steroids
rehydration
(same as gout)
what condition would you suspect if you saw red clumps on the microscope in a 50 year old female complaining of shoulder pain?
hydroxyapatite crystal deposition
