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MSK SM > Osteoarthritis, Crystal Arthritis and Soft Tissue Rheumatism > Flashcards

Osteoarthritis, Crystal Arthritis and Soft Tissue Rheumatism Flashcards

1
Q

What is the most common musculoskeletal disorder?

A

Osteoarthritis

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2
Q

What is osteoarthritis

A

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

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3
Q

What does cartilage mostly consist of

A

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

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4
Q

How is the matrix of the cartilage formed

A

By the chondrocytes which are embedded within it

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5
Q

What are some of the contributing factors to Osteoarthritis

A 
Age 
Obesity 
Lack of osteoporosis 
Occupation
Sports 
Previous injury 
Muscle weakness 
Genetics
Female vs male sex
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6
Q

In OA, what is there a release in?

A

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

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7
Q

How are bone cysts caused in OA

A

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

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8
Q

What are the two types of osteoarthritis?

A

Idiopathic and secondary

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9
Q

What joints are commonly affected in localised idiopathic OA

A 
Hands 
Feet
Knee
Hip
Spine
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10
Q

What is generalised idiopathic osteoarthritis

A

Involvement of three or more sites

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11
Q

What can lead to secondary OA

A

Previous injury
Acromegaly
Calcium crystal deposition disease

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12
Q

What are the common presentations of OA

A

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

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13
Q

How long does the stiffness last in RA

A

more than 30 mins

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14
Q

What are 2 of the findings found on examination of OA

A

Crepitus

Bony enlargements due to osteophytes

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15
Q

What is crepitus

A

Bone rubbing against bone

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16
Q

What joints are affected by OA

A

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

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17
Q

What are the names of the bony enlargements seen at DIPs

A

Heberdens nodes

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18
Q

What are the bony enlargements seen in the PIPs

A

Bouchards nodes

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19
Q

Describe the difference between Genu varus and Genu valgus

A 
Varus = knees moving towards the midline
Valgus = knees moving away from the midline
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20
Q

What is a Bakers cyst

A

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

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21
Q

Where might pain be felt in an OA hip joint

A

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

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22
Q

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

A

Cervical and Lumbar

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23
Q

What happens in Cervical OA

A

Pain and restriction of movement

Osteophytes may impinge on nerve roots

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24
Q

What happens in Lumbar OA

A

Osteophytes can cause spinal stenosis if they encroach on spinal canal

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25
Q

What is spinal claudication

A

Narrowing of the spinal canal

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26
Q

How do we make a diagnosis of OA

A 
Clinical and radiological 
Loss of joint space (due to loss of cartilage)
Subchondral sclerosis 
Subchondral cysts 
Osteophytes
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27
Q

How do we grade OA

A

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

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28
Q

What are the non-pharmacological management for OA

A

Physiotherapy - muscle strengthening, proprioceptive
Weight loss
Exercise
Walking stick

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29
Q

What are the pharmacological measures for OA

A

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

30
Q

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

A

Steroids (especially in later stages)

Hyaluronic acid

31
Q

What surgical procedures can be done in OA

A

Arhtroscopic washout
Loose body
Soft tissue trimming
JOINT REPLACEMENT

32
Q

What is gout?

A

inflammation in the joint triggered by uric acid crystals

33
Q

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

A

True

34
Q

When does the incidence and prevalence of gout increase in women

A

After the menopause

35
Q

What results in crystallisation

A

Hyperuricemia

36
Q

What are some of the causes of hyperuricaemia

A 
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)
37
Q

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

A

about 10 days

38
Q

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

A

About 3 days

39
Q

What joints are commonly affected in acute gout

A

1st MTP > ankle > knee

40
Q

What is chronic tophaceous gout

A

Chronic joint inflammation which is often diuretic associated

41
Q

What can be tests for chronic tophaceous gout

A

Serum uric acid is usually increased

42
Q

What investigations can we do for gout

A 
Serum uric acid 
Raised inflammatory markers 
Polarising microscopy of synovial fluid 
Renal impairment 
XRays
43
Q

What is the treatment for acute gout

A

NSAIDs
Colchicine
Steroids

44
Q

What prophylactic treatment is given for gout

A

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

45
Q

What is calcium pyrophosphate deposition disease related to

A

Osteoarthritis

46
Q

What joints does calcium pyrophosphate deposition disease affect

A

Fibrocartilage - knees, wrists and ankles

47
Q

How does calcium pyrophosphate deposition (CPPD) disease come about

A

Calcium pyrophosphate gets deposited in the cartilage and causes inflammation

48
Q

What causes acute attacks of CPPD

A

Calcium pyrophosphate crystals (psuedogout)

49
Q

Describe the apparence of calcium pyrophosphate crystals

A

Envelope shaped

50
Q

What is increased in CPPD

A

Inflammatory markers

51
Q

Describe the treatment of CPPD

A 
No long term treatment - just treat the flares for as and when they come using:
NSAIDs 
Colchicine
Steroids
Rehydration
52
Q

What is Milwaukee shoulder

A

Hydroxyapatite

53
Q

How does Hydroxypatite occur?

A

Hydoxyapatite crystal deposition in or around the joint

Release of collagenases serine proteinases and IL1

54
Q

Who is likely to be affected by Hydroxyapatite

A

Females aged between 50 and 60

55
Q

What is the prognosis for Hydroxyapatite

A

Acute and rapid deterioration in the humeral head

56
Q

What is the treatment for Hydroxyapatite

A

NSAIDs
Intra-articular steroid injection
Physiotherapy
Partial or total arthroplasty

57
Q

What is soft tissue rheumatism

A

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

58
Q

Where is the pain located in soft tissue rheumatism

A

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

59
Q

What should be considered for more generalised soft tissue pain

A

Fibromyalgia

60
Q

What should be considered in a patient presenting with neck pain

A

OA of cervical spine

Occipital migraine

61
Q

Where is the most common site for soft tissue pain

A

The shoulder

62
Q

What soft tissue injuries can occur in the shoulder joint

A 
Adhesive capsulitis 
Rotator cuff tendinosis
Calcific tendonitis 
Impingement
partial rotator cuff tears 
full rotator cuff tears
63
Q

What is a common soft tissue injury of the foot

A

Plantar fascitis

64
Q

What are a common soft tissue injury of the elbow

A

Medial and lateral epicondylitis

Cubital tunnel syndrome

65
Q

What are common soft tissue injuries of the wrist

A

De-Quervains tenosynovitis

Carpal tunnel syndrome

66
Q

What are common soft tissue injuries of the pelvis

A

Trochanteric Ilipsoas
Ischiogluteal bursitis
Stress enthesopathies

67
Q

What are the usual investigations performed for suspected soft tissue injuries

A

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

68
Q

What are some treatment options for soft tissue injuries

A 
Pain control 
Rest and ice compressions 
PT 
Steroid injections
Surgery
69
Q

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

A

Marfan’s syndrome

Ehlers Danlos syndrome

70
Q

When does joint hyper mobility present ?

A

Childhood or 3rd decade

71
Q

When is hyper mobility diagnosed using the modified brighten score

A

If 4/9 or more is scored

72
Q

What is the treatment for Hypermobility

A

Physiotherapy

Explanation

MSK SM (42 decks)

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