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Aging > Osteoarthritis and Gout > Flashcards

Osteoarthritis and Gout Flashcards

1
Q

What does OA result from

A

joint integrity, genetics, local inflammation, mechanical forces, metabolic diseases

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2
Q

What happens in OA

A

Disease of chondrocytes: Cartilage is lost resulting in the degradation of matrix. Cartilage is replaced by bone

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3
Q

What are the RF for OA

A

Biomechanics: excessive load: knee (8x), hip, hand (3x increase). 25% of UK population obese
Women have 3x increase chance of OA. Menopausal arthritis is a well-recognised phenomenon. Hormonal factors thought to play a role.
Negative correlation between osteoporosis and OA

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4
Q

What are the hand signs for OA

A

Metacarpal pharyngeal joints tend to be spared
DIJ: Hebeden’s
PIJ: Bouchard
Bony swelling

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5
Q

What are the pain symptoms of OA

A

Principle symptom is pain: typically exacerbated by activity and relieved by rest. Inactivity gelling is common, although morning stiffness typically lasts less than 30 minutes

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6
Q

What are the examination findings of OA

A

Predilection for fingers, knees, hips and spine
Rarely affects elbows, wrists (except carpal metacarpal joint)or ankles
Joint tenderness
Bony enlargement
Effusions
Crepitus

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7
Q

What are the radiograph findings of OA

A

loss of join space, joint line sclerosis, osteophytes, subchondral cysts (white line

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8
Q

What is avascular necrosis in hip

A

loss of blood supply to femoral head. Can occur in complication of OA.

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9
Q

What is the treatment for OA

A

Weight loss, physio, pain relief, joint replacement. Start by looking at non-medication based treatment

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10
Q

What is gout

A

build up on uric acid due to purine metabolism. Xanthine oxidase is key enzyme to turn purine to uric acid.

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11
Q

What are the clinical features of gout

A

Severe pain of rapid onset
First attack always single joint and never axial skeleton
Great toe MTPJ > 50%
Subsequently any join

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12
Q

What is tophus

A

Tophus is a deposit of uric acid crystals: can occur in subcutaneous, elbows and ears as well
Bone will be eroded under tophus. Tophus is radio-lucent and will be peri-articular
Scleroderma has similar radiological findings

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13
Q

What do uric crystal deposits in kidneys do

A

interstitial disease

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14
Q

How is diagnosis confirmed

A

Diagnosis can be confirmed with arthrocentesis
Crystals are negatively birefringent
Calcium pyrophosphate crystals are positively birefringent

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15
Q

What is the treatment for OA

A

xanthine oxidase inhibitors. Look out for azathioprine

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16
Q

What is pseduogout

A

calcium pyrophosphate disease

17
Q

What are the RF for pseudogout

A

advancing age, prior joint trauma, familial chrondrocalcinosis, hemochromatosis, hyperparathyroidism hypomagnesemia and hypophosphatasia

18
Q

What are the signs of pseduogout

A

Mono or oligoarticular disease seen in 89% of cases
Rapid onset severe joint pain
Peak intensity within 6-24 hours
Fever
Overlying erythema and desquamation
Resolution in 3-4 days
Chondrocalcinosis radiological hallmark of pseudogout

19
Q

Who should not get gout

A

Pre-menopausal women should not get gout

20
Q

What is acute gout caused by

A

fluctuations in serum urate. Measuring uric acid during an attack is not helpful.
Hyperuricemia in males is over 042, and in females over 0.36

21
Q

What are the RF for gout

A

hyperuricemia, persistent alcoholic consumption, diuretic use, high BMI, lipid disorders, older age, male sex, genetics
Fructose has no effect on satiety. Massive RF for gout

22
Q

What’s the difference in birefrigency between gout and pseudo

A

Gout negative

Pseduogout positive

23
Q

What is the distribution of OA

A

Predilection for fingers, knees, hips, and spine

Rarely affects the elbows, wrists, or ankles

24
Q

What is the pathway of OA treatment

A

Topicals->Paracetamol->NSAIDS/COX2->Intra-articular steroid
Co-prescribe PPI with NSAIDS/COX2
Caution with use of NSAIDs alongside low dose aspirin
Do not offer: glucosamine or chondroitin, intra-articular hyaluronan

25
Q

What is the pathway of purine metabolism

A

Hypoxanthine->Xanthine->Uric acid

26
Q

What is purine metabolism catalysed by

A

Xanthine Oxidase

27
Q

What are hyperuricaemia levels

A

Males: >0.42mmol/L
Females: >0.36mmol/L

28
Q

What are treatment options for gout

A

NSAIDS: naproxen - avoid in renal, cardiac, or liver disease
Colchicine: 1 mg STAT
Prednisolone: 30 mg od - caution in DM/CCF

Xanthine oxidase inhibitors to prevent recurrence
Allopurinol - rash and risk of DRESS
Fexbuxostat - occur in eGFR, beware theophylline

Aging (8 decks)

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