Osteoarthritis, Crystal Arthritis and Soft Tissue Rheumatism

Question 1

What is the most common musculoskeletal disorder?

Answer 1

Osteoarthritis

Question 2

What is osteoarthritis

Answer 2

Articular cartilage failure - Thinning or loss of
subchondral sclerosis
Loss of joint space
Subchondral cyst formation

Question 3

What does cartilage mostly consist of

Answer 3

Collagen type 2 fibres linked by covalent bonds giving them good strength

Question 4

How is the matrix of the cartilage formed

Answer 4

By the chondrocytes which are embedded within it

Question 5

What are some of the contributing factors to Osteoarthritis

Answer 5

Age 
Obesity 
Lack of osteoporosis 
Occupation
Sports 
Previous injury 
Muscle weakness 
Genetics
Female vs male sex

Question 6

In OA, what is there a release in?

Answer 6

Cytokines including IL-1, TNF and mixed metalloproteinases as well as prostoglandins by the chondrocytes

Question 7

How are bone cysts caused in OA

Answer 7

When there is no cartilage left covering the surfaces of the joint, the bone is exposed and the synovial fluid goes into the bone causing cysts to develop

Question 8

What are the two types of osteoarthritis?

Answer 8

Idiopathic and secondary

Question 9

What joints are commonly affected in localised idiopathic OA

Answer 9

Hands 
Feet
Knee
Hip
Spine

Question 10

What is generalised idiopathic osteoarthritis

Answer 10

Involvement of three or more sites

Question 11

What can lead to secondary OA

Answer 11

Previous injury
Acromegaly
Calcium crystal deposition disease

Question 12

What are the common presentations of OA

Answer 12

Pain which is typically worse on activity and relieved by rest (mechanical pain)
Stiffness in the morning which lasts less than 30 minutes

Question 13

How long does the stiffness last in RA

Answer 13

more than 30 mins

Question 14

What are 2 of the findings found on examination of OA

Answer 14

Crepitus

Bony enlargements due to osteophytes

Question 15

What is crepitus

Answer 15

Bone rubbing against bone

Question 16

What joints are affected by OA

Answer 16

All weight bearing joints in the lower limbs
Spine (not thoracic)
Hands (DIP, PIP, 1st IP and 1st CMC and carpal metacarpal joints)

Question 17

What are the names of the bony enlargements seen at DIPs

Answer 17

Heberdens nodes

Question 18

What are the bony enlargements seen in the PIPs

Answer 18

Bouchards nodes

Question 19

Describe the difference between Genu varus and Genu valgus

Answer 19

Varus = knees moving towards the midline
Valgus = knees moving away from the midline

Question 20

What is a Bakers cyst

Answer 20

A fluid filled swelling that develops at the back of the knee (popliteal fossa)

Question 21

Where might pain be felt in an OA hip joint

Answer 21

Int he groin
radiating to the knee
radiating from the lower back

Question 22

What 2 parts of the spine are most commonly affected by OA

Answer 22

Cervical and Lumbar

Question 23

What happens in Cervical OA

Answer 23

Pain and restriction of movement

Osteophytes may impinge on nerve roots

Question 24

What happens in Lumbar OA

Answer 24

Osteophytes can cause spinal stenosis if they encroach on spinal canal

Question 25

What is spinal claudication

Answer 25

Narrowing of the spinal canal

Question 26

How do we make a diagnosis of OA

Answer 26

``` Clinical and radiological Loss of joint space (due to loss of cartilage) Subchondral sclerosis Subchondral cysts Osteophytes ```

Question 27

How do we grade OA

Answer 27

Kellgren-Lawrence Radiographic grading scale 0 = normal 4= late stage

Question 28

What are the non-pharmacological management for OA

Answer 28

Physiotherapy - muscle strengthening, proprioceptive Weight loss Exercise Walking stick

Question 29

What are the pharmacological measures for OA

Answer 29

Analgesia - parqacetamol, compound analgesics, topical analgesia NSAIDs Pain modulators - tricyclics e.g. amitriptyline, anticonvulsants e.g. gabapentin

Question 30

What intra-articular management can be given to patients with RA

Answer 30

Steroids (especially in later stages) | Hyaluronic acid

Question 31

What surgical procedures can be done in OA

Answer 31

Arhtroscopic washout Loose body Soft tissue trimming JOINT REPLACEMENT

Question 32

What is gout?

Answer 32

inflammation in the joint triggered by uric acid crystals

Question 33

Men are more likely to have gout than women. True or False

Answer 33

True

Question 34

When does the incidence and prevalence of gout increase in women

Answer 34

After the menopause

Question 35

What results in crystallisation

Answer 35

Hyperuricemia

Question 36

What are some of the causes of hyperuricaemia

Answer 36

``` Psoriasis Haemolytic disorders Alcohol - beer and spirits High dietary purine intake (red meat, seafood etc) Inherited enzyme defects Chronic renal impairment Volume depletion (heart failure) Hypothyroidism Diuretics Cytotoxics (cyclosporin) ```

Question 37

How long would it take for acute gout to settle on its own

Answer 37

about 10 days

Question 38

With treatment, how long would it take for acute gout to settle

Answer 38

About 3 days

Question 39

What joints are commonly affected in acute gout

Answer 39

1st MTP > ankle > knee

Question 40

What is chronic tophaceous gout

Answer 40

Chronic joint inflammation which is often diuretic associated

Question 41

What can be tests for chronic tophaceous gout

Answer 41

Serum uric acid is usually increased

Question 42

What investigations can we do for gout

Answer 42

``` Serum uric acid Raised inflammatory markers Polarising microscopy of synovial fluid Renal impairment XRays ```

Question 43

What is the treatment for acute gout

Answer 43

NSAIDs Colchicine Steroids

Question 44

What prophylactic treatment is given for gout

Answer 44

Allopurinol Febuxostat Started 2-4 weeks after acute attack Require cover with NSAID

Question 45

What is calcium pyrophosphate deposition disease related to

Answer 45

Osteoarthritis

Question 46

What joints does calcium pyrophosphate deposition disease affect

Answer 46

Fibrocartilage - knees, wrists and ankles

Question 47

How does calcium pyrophosphate deposition (CPPD) disease come about

Answer 47

Calcium pyrophosphate gets deposited in the cartilage and causes inflammation

Question 48

What causes acute attacks of CPPD

Answer 48

Calcium pyrophosphate crystals (psuedogout)

Question 49

Describe the apparence of calcium pyrophosphate crystals

Answer 49

Envelope shaped

Question 50

What is increased in CPPD

Answer 50

Inflammatory markers

Question 51

Describe the treatment of CPPD

Answer 51

``` No long term treatment - just treat the flares for as and when they come using: NSAIDs Colchicine Steroids Rehydration ```

Question 52

What is Milwaukee shoulder

Answer 52

Hydroxyapatite

Question 53

How does Hydroxypatite occur?

Answer 53

Hydoxyapatite crystal deposition in or around the joint | Release of collagenases serine proteinases and IL1

Question 54

Who is likely to be affected by Hydroxyapatite

Answer 54

Females aged between 50 and 60

Question 55

What is the prognosis for Hydroxyapatite

Answer 55

Acute and rapid deterioration in the humeral head

Question 56

What is the treatment for Hydroxyapatite

Answer 56

NSAIDs Intra-articular steroid injection Physiotherapy Partial or total arthroplasty

Question 57

What is soft tissue rheumatism

Answer 57

The general term to describe pain that is caused by inflammation / damage to ligaments, tendons, muscles or nerve near a joint rather than either the bone or cartilage

Question 58

Where is the pain located in soft tissue rheumatism

Answer 58

Confined to a specific site e.g. shoulder, wrist etc.

Question 59

What should be considered for more generalised soft tissue pain

Answer 59

Fibromyalgia

Question 60

What should be considered in a patient presenting with neck pain

Answer 60

OA of cervical spine | Occipital migraine

Question 61

Where is the most common site for soft tissue pain

Answer 61

The shoulder

Question 62

What soft tissue injuries can occur in the shoulder joint

Answer 62

``` Adhesive capsulitis Rotator cuff tendinosis Calcific tendonitis Impingement partial rotator cuff tears full rotator cuff tears ```

Question 63

What is a common soft tissue injury of the foot

Answer 63

Plantar fascitis

Question 64

What are a common soft tissue injury of the elbow

Answer 64

Medial and lateral epicondylitis | Cubital tunnel syndrome

Question 65

What are common soft tissue injuries of the wrist

Answer 65

De-Quervains tenosynovitis | Carpal tunnel syndrome

Question 66

What are common soft tissue injuries of the pelvis

Answer 66

Trochanteric Ilipsoas Ischiogluteal bursitis Stress enthesopathies

Question 67

What are the usual investigations performed for suspected soft tissue injuries

Answer 67

X-Ray - calcific tendonitis MRI if fails to settle Identify precipitating factors

Question 68

What are some treatment options for soft tissue injuries

Answer 68

``` Pain control Rest and ice compressions PT Steroid injections Surgery ```

Question 69

What 2 rare genetic syndromes are related to joint hyper mobility syndrome

Answer 69

Marfan's syndrome | Ehlers Danlos syndrome

Question 70

When does joint hyper mobility present ?

Answer 70

Childhood or 3rd decade

Question 71

When is hyper mobility diagnosed using the modified brighten score

Answer 71

If 4/9 or more is scored

Question 72

What is the treatment for Hypermobility

Answer 72

Physiotherapy | Explanation