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Musculoskeletal > Osteoarthritis and Crystal Arthropathies > Flashcards

Osteoarthritis and Crystal Arthropathies Flashcards

1
Q

What is the prevalence of osteoarthritis?

A

1/3 of population in > 45’s, 1/2 of population in > 70’s

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2
Q

What is osteoarthritis?

A

Articular cartilage thinning or loss

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3
Q

What are risk factors for cartilage loss?

A

Age, female, obesity, previous injury, muscle weakness, proprioceptive deficits, genetics, acromegaly, joint inflammation, crystal arthropathies

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4
Q

What are the types of osteoarthritis?

A

Idiopathic, secondary (previous injury, calcium crystal deposition disease etc)

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5
Q

What is the distribution of osteoarthritis?

A

Hip, knee, cervical and lumbar spine, MTP joints, DIP, PIP, 1st IP, 1st MCP, CMC

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6
Q

What are the symptoms of osteoarthritis?

A

Pain = worse on activity and relived by rest (mechanical pain)
Stiffness

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7
Q

What can be seen on examination of patients with osteoarthritis?

A

Crepitus, joint swelling (bony enlargements due to osteophytes), joint tenderness and effusions

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8
Q

What are the clinical features of osteoarthritis of the hands?

A

DIP, PIP and 1st CMC joints, bony enlargements of DIPs (Heberden’s nodes) and of PIPs (Bouchard’s nodes), squaring of hands

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9
Q

What are the clinical features of osteoarthritis of the knees?

A

Osteophytes, effusions, crepitus, reduced ROM, genu varus or valgus, Baker’s cyst

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10
Q

What are the clinical features of osteoarthritis of the hip?

A

Pain may be felt in groin or radiating to knee (pain felt at hip may also be radiating from the lower back), reduced ROM

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11
Q

What are the clinical features of osteoarthritis affecting the cervical spine?

A

Pain and restriction of neck movement

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12
Q

What are the clinical features of osteoarthritis of the lumbar spine?

A

Pain on standing or walking for some time, osteophytes causing spinal stenosis (if encroaching on spinal cord or pinching nerve root)

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13
Q

What are the radiological signs of osteoarthritis?

A

Loss of joint space, subchondral sclerosis and cysts, osteophytes

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14
Q

What is the Kellgren-Lawrence Radiographic Grading Scale of osteoarthritis?

A

Grade 0 = no radiographic findings of osteoarthritis
Grade 1 = minute osteophytes of doubtful clinical significance
Grade 2 = definite osteophytes with unimpaired joint space
Grade 3 = Definite osteophytes with moderate joint space narrowing
Grade 4 = definite osteophytes with severe joint space narrowing and subchondral sclerosis

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15
Q

What is the natural history of osteoarthritis?

A

Small joints of hands = over 2 years pain improves but swelling gets worse
Knees = 1/3 improve, 1/3 stay the same, 1/3 get worse
Hip = 10% come of surgical waiting lists as symptoms improve

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16
Q

What are the non-pharmacological treatments of osteoarthritis?

A

Physiotherapy = muscle strengthening, proprioceptive

Weight loss exercise, trainers, walking stick, insoles

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17
Q

What are some pharmacological managements of osteoarthritis?

A

Analgesia = paracetamol, compound/topical analgesia
NSAIDs = topical/systemic, consider risk/benefit ratio
Pain modulators = tricyclics (e.g amitryptiline), anticonvulsants (e.g Gabapentin)
Intra-articular steroids

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18
Q

What are some surgical treatments of osteoarthritis?

A

Arthroscopic washout, loose body, soft tissue trimming, joint replacement

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19
Q

What is gout?

A

Inflammation in joint triggered by uric acid crystals

20
Q

What are some causes increased urate production?

A

Inherited enzyme defects, myeloproliferative/lymphoproliferative disorders, psoriasis, haemolytic disorders, alcohol, high dietary purine intake

21
Q

What are some causes of reduced urate excretion?

A

Chronic renal impairment, volume depletion (e.g heart failure), hypothyroidism, diuretics, cytotoxics (e.g cyclosporin)

22
Q

What is the epidemiology of gout?

A

1.4% UK prevalence, 7% in men > 65 and 3% in women >85, more common in men (4:1), rare in women before menopause

23
Q

What are some features of acute gout?

A

Usually monoarthropathy = 1st MTP>ankle>knee,

may have normal uric acid levels, renal impairment (may be cause or effect)

24
Q

What is the onset of acute gout?

A

Abrupt onset, usually overnight = normally settles in 10 days without treatment (3 days with treatment)

25
Q

What are some features of chronic tophaceous gout?

A

Chronic joint inflammation, may get acute attacks, often diuretics associated, high serum uric acid, tophi

26
Q

What are some investigation result positive for gout?

A

Raised inflammatory markers, serum uric acid usually raised, synovial fluid shows needle shaped negatively birefringent crystals on polarising microscopy, x-ray

27
Q

What is the treatment for acute gout?

A

NSAIDs, colchicine, steroids

28
Q

What is prophylactic treatment for gout?

A

Allopurinol, februxostat, start 2-4 weeks after acute attack, require cover with NSAIDs etc

29
Q

Who gets calcium phosphate deposition disease, and where does it occur?

A

More common in elderly = chondrocalcinosis increases with age
Affects fibrocartilage = knees, wrists, ankles

30
Q

What are the two kinds of calcium phosphate deposition diseases?

A

Calcium pyrophosphate and calcium hydroxyapatite crystals

31
Q

What causes acute attacks of calcium phosphate deposition disease?

A

Calcium pyrophosphate crystals (pseudogout) = rhomboid mildly positive birefringent crystals, marked rise in inflammatory markers

32
Q

What is the treatment for pseudogout?

A

NSAIDs, colchicine, steroids, rehydration

33
Q

What causes Milwaukee shoulder?

A

Hydroxyapatite crystal deposition in or around the shoulder joint = release of collagenases, serine proteases and IL-1

34
Q

What are some features of Milwaukee shoulder?

A

Acute and rapid deterioration, occurs in females aged 50-60

35
Q

How is Milwaukee shoulder treated?

A

NSAIDs, intra-articular steroid injection, physiotherapy, partial or total arthroplasty

36
Q

What is soft tissue rheumatism?

A

General term to describe pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerves near a joint

37
Q

Where is the pain of soft tissue rheumatism felt?

A

Confined to specific site (e.g neck, shoulder etc)

38
Q

What are some features of soft tissue rheumatism of the neck?

A

Muscular, usually self limiting, consider osteoarthritis of cervical spine etc

39
Q

What are some features of soft tissue rheumatism of the shoulder?

A

Most common site, adhesive capsulitis, rotator cuff tendinosis, calcific tendonitis, impingement, partial or full rotator cuff tears

40
Q

What are some features of soft tissue rheumatism of the elbow, wrist and foot?

A 
Elbow = medial and lateral epicondylitis, cubital tunnel syndrome
Wrist = De-Quervain's tenosynovitis, carpal tunnel syndrome
Foot = plantar fasculitis
41
Q

What are some features of soft tissue rheumatism of the pelvis?

A

Trochanteric and iliopsoas, ischiogluteal bursitis, stress enthesopathies

42
Q

What are some investigations that can be done for soft tissue rheumatism?

A

Tests usually unnecessary, x-ray (calcific tendonitis), MRI if fails to settle, identify precipitating factors

43
Q

What are some treatments of soft tissue rheumatism?

A

Pain control, rest and ice compression, physiotherapy, steroid injections, surgery

44
Q

What is the aetiology of joint hypermobility syndrome?

A

More common in females, general or local, linked to Marfan’s syndrome and Ehlers Danlos syndrome, usually presents in childhood or 30’s

45
Q

What is the modified Beighton score for joint hypermobility syndrome?

A

> 10 degrees hyperextension of the elbows
Passively tough the forearm with the thumb while flexing the wrist
Passive extension of fingers or a 90 degree or more extension of the 5th finger
Knees hyperextension >= 10 degrees
Touching the floor with the palms of the hands when reaching down without bending the knees

46
Q

What score on the modified Beighton score indicates joint hypermobility syndrome?

A

If score > 4/9

47
Q

What are some features of joint hypermobility syndrome?

A

Presents with arthralgia, premature osteoarthritis, normal investigations, treated with physiotherapy

Musculoskeletal (57 decks)

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