Osteoarthritis, crystal arthritis and soft tissue rheumatism Flashcards
What is oseoarthritis?
Articular cartilage thinning or loss
What are some risk factors for cartilage loss?
Age Female Obesity Previous injury Muscle weakness Acromegaly Joint inflammation Crystal deposition
What is an osteophyte?
A bony projection associated with the degeneration of cartilage at joints
What are the different types of oestoarthritis?
Idiopathic
Secondary: previous injry, calcium crystal deposition, rheumatoid arthritis
What joints are likely to be affected by osteoarthritis?
Weight bearing joints: hips, knees, lumbar spie
Joints used alot: cervical spine, thumb
How will osteoarthritis present?
Pain - typically worse on activity and relived by rest. May progress to be present with less activity and at rest/night
Stiffness - morning stiffness that lasts less than 30mins
What can be seen on examintation of oestoarthritis?
Crepitus
Joint swelling
Joint tenderness
Joint effusion - late presentation
Where can oesoarthritis affect in the hands?
DIP, PIP and 1st CMC joints
What is heberdens nodes?
DIP bony enlargements
What is bouchards nodes?
PIP bony enlargement
What can occur in oesteoarthritis of the knee?
Oseophytes Effusions Crepitus Restriction of movement Genu varus and valgus Bakers cyst
Where can pain be felt in hip osteoarthritis?
Groin or referered to knee or lower back
What effect will oestoearthritis of the cervical spine have?
Pain and restiction of neck movement
What effects can spinal osteophytes have?
Spinal stenosis
Pinching of nerve root
What are the radiological findings of osteoarthritis?
LOSS Loss of joint space Osteophytes Subchondral sclerosis Subchondral cysts
What grading scale is used for oestoarthritis?
Grade 0: no radiographic findings of osteoarthritis
Grade 4: definite osteophytes with severe joint space narrowing and subchondral sclerosis
What is osteosclerosis?
Abnormal hardening of bone and elevation of bone density
What are the non-pharma managements of osteoarthritis?
Explanation
Physiotherapy to strengthen muscles
Common sense measures; weight loss, exercise, trainers, walking stick, insoles
What are the pharma managements of oesteoarthritis?
Analgeisa; paracetamol, topical analgesia
NSAIDs. topical or systemic
Pain modulators; tricyclics e.g. amitryptiline, anti-convulsants e.g. gabapentin
Intra-articular; steroids
What are the surgical managements of osteoarthritis?
Joint replacement is the onyl definitve treatment for osteoarthritis
What is gout?
Inflammation in the joint triggered by uric acid crystals
What levels of uric acid in the blood cause gout?
> 0.42 mmol/l is considered hyperuricaemia
What can cause an increased urate production?
Inherited enzyme defects Psoriasis Haemolytic disorders Alcohol (beer/ spirits) High dietary purine intake
What can cause reduced urate excretion?
Chronic renal impairement Volume depletion e.g. heart fialure Hypothyrodism Diuretics Cytotoxics e.g. cyclosporin
How long does it tend to take acute gout to settle?
10 days without treatment
3 days with treatment
What is chronic tophaceous gout?
Chronic joint inflammation
Often diuretic associated
High serum uric acid
What investigations are done for gout?
Raised inflammatory markers
Serum uric acid rasied
Synoival fluid aspiration
Renal impairement
What will synovial fluid aspiration show?
Polarising microscopy shows needle shaped negatively birefringent crystals
How is actue gout treated?
NSAIDs
Colchicine
Steroids
What is the prophylaxis for gout?
Allopurinol 2/4 weeks after actute attck
Where will calcium pyrophosphate affect?
Fibrocartilgae; knees, wrists and ankles
What are the two different types of calcium pyrophosphate deposition disease?
Calcium pyrophosphate
Calcium hydroxyappatite crystal
What is the more common name for calcium pyrophosphate deposion disease?
Pseudogout
What do CPPD crystals look like?
Rhomboid shaped with a mild positve birefringent
How is pseudogout treated?
NSAIDs
Colchicine
Steroids
Rehydration
Where will hydroxyapatite crystals gather?
In or around the joint
Who will hydroxyapatite affect?
Females 50/60s
What is the treatment for hydroxyapatite?
NSAIDs
Intra-articular steroid injection
Physio
Partial or total arthroplasty
What is soft tissue rheumatism?
General term to describe pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerves near a joint
What type of pain will soft tissue rheumatism cause?
Confined to a specific site; shoulder, wrist
What should be in the differential of muscular neck pain?
OA of cervical spine
Occipital migrane
What can cause shoulder pain?
Adhesive capsulitis Rotator cuff tendonitis Calcific tendonitis Impingement Partial rotator cuff tears Full rotator cuff tears
What is golf elbow?
Medial epicondylitis
What is tennis elbow?
Lateral epicondlylitis
What can cause pain in the wrist?
De-quervains tenosynovitis
What can cause pelvic pain?
Trochanteic, iliopsoas and ichiogluteal bursitis and stress enthesopathies
What can cause foot pain?
Plantar fascitiis
How is soft tissue rheumatism investigated?
X-ray - calcific tendonitis
MRI if fails to settle
How is soft tissue rheumatism treated?
Pain control Rest and ice PT Steroid injections Surgery
What rare conditions can cause joint hypermobility?
Marfan’s syndrome
Ehlers danlos syndrome
What is included in the modified beighton score?
>10 degrees hyperextension of elbows Passively touch forearm with thumb Passive extension of fingers Knees hyperextension over 10 degrees Touching floor with palms when knees straight
What score do you need to get in the modified beighton score to be diagned with hypermobility?
A score of 4
