Osteoarthritis, Crystal Arthritis and Soft tissue rheumatism Flashcards
what does osteoarthritis look like on x-ray
no cartilage
bones are tight together
what is osteoarthritis
articular cartilage thinning or loss
risk factors for osteoarthritis
age female obestity previous injury muscle weakness proprioceptive deficits genetic elements acromegaly joint inflammation crystal deposition in cartilage
what causes secondary osteoarthritis
previous injury
calcium crystal deposition
rheumatoid arthritis
what are the two types of osteoarthritis
idiopathic
secondary
symptoms of osteoarthritis
pain- typically worse on activity and relieved by rest
stiffness - early morning lasting less than 30 mins
clinical presentation of osteoarthritis
crepitus
joint swelling - bony enlargements due to osteophytes
joint tenderness
joint effusion
clinical features in the hands
DIP, PIP and 1st CMC joints
body enlargements may be seen at DIP
squaring of the hand
clinical features in the knee
osteophytes effusions crepitus and restriction of movement genu varies and values bakers cyst
clinical features in the hip
pain felt in groin or radiating to knee
pain felt in hip may be radiating from lower back
hip movements restricted
clinical features in the spine
cervical pain and restriction of neck movement
lumbar - pain on standing or walking for some time
osteophytes can cause spinal stenosis if encroach on spinal canal or pinch the nerve route
radiological features of osteoarthritis
loss of joint space
subchondral sclerosis
subchondral cysts
osteophytes
what is the kellgren Lawrence scare
radiographic grading scale of osteoarthritis
what is grade 0
no radiographic findings of osteoarthritis
grade 1
minute oestophytes of doubtful clinical significance
grade 2
definite osteophytes with unimpaired joint space
grade 3
definite osteophytes with moderate joint narrowing
grade 4
definite osteophytes with severe joint space narrowing and subchondral sclerosis
non-pharmacologic treatments
physiotherapy -muscle strengthening
proprioceptive
common sense measures (weight loss, exercise, trainers, walking stick)
pharmacological treatments
analgesia
NSAIDS
Pain modulators
Intra articular steroids
surgical management
arthroscopic washout, loose body, soft tissue trimming
joint replacement
what is gout
inflammation in the joint triggered by uric acid crystals
what is hyperuriceamia
uric acid >0/42mmol/l
what causes hyperuriceamia
increased rate production
reduced urate excretion
what causes increased urate production
inherited enzyme defects psoriasis haemolytic disorders alcohol high dietary purine intake (red meat, seafood, corn syrup)
what causes reduced urate excretion
chronic renal impairment volume depletion eg. heart failure hypothyroidism diuretics cytotoxics
describe acute gout
monoarthopathy
settles in abut 10 days without treatment
settles in 3 days with treatment
abrupt onset, often overnight
may have normal uric acid during acute attack
