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msk > Osteoarthritis, Crystal Arthritis and Soft Tissue Rheumatism > Flashcards

Osteoarthritis, Crystal Arthritis and Soft Tissue Rheumatism Flashcards

1
Q

what is osteoarthritis

A

articular cartilage thinning or loss

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2
Q

what are the risk factors for osteoarthritis

A

age, female, obesity, previous injury, occupation (farmers), sports activities, muscle weakness, proprioceptive defercts, genetic elements, acromegaly, joint inflammation, crystal deposition in cartilage

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3
Q

what can cause the pathogenesis caused osteoarthritis

A

altered mechanical loading of cartilage, bone and liagments

proteolytic destruction of cartilage matrix and chondrocyte death

reduced synovial fluid viscosity

synovial inflammation

chrondroyte death

collage fibre and/or proteoglycan damage

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4
Q

what are the two types of osteoarthritis

A

idiopathic and secondary

secondary= previous injury =, calcium crystal deposition, rheumatoid arthritis

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5
Q

what joints are affected by osteoarthritis

A

load bearing ones:

  • cervical spine
  • lumbar spine
  • hand (DIP, PIP, 1st IP, 1st MCP (1st thumb), CMC0
  • hip
  • knee
  • foot (MTP)
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6
Q

what are the symptoms of osteoarthritis

A

pain: worse on activity, relieved by rest= mechanical pain . may progress to be present at rest/night
stiffness: morning stiffness lasting less than 30mins= inactivity gelling (stiffness in the morning or after rest)

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7
Q

what is seen on examination of a patent with osteoarthritis

A

crepitus (bone rubbing on bone)

joint swelling- bone enlargements due to osteophytes

joint tenderness

joint effusion (due to secondary inflammation within the joint)

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8
Q

what clinical features of osteoarthritis are seen in the hands

A

DIP, PIP and 1st CMC joints affected

bony enlargements may be seen at DIPs (heberdens nodes) and PIPs (bouchards nodes)

squaring of the hands

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9
Q

what clinical features of osteoarthritis are seen in the knees

A

osteophytes, effusions, crepitus and restriction of movement

Genu varus (leg goes inward) or valgus (leg away from midline) deformities

bakers cyst (at back of knee)

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10
Q

what clinical features of osteoarthritis are seen in the hip

A

pain may be felt in groin or radiating to knee or radiating from the lower back

hip movements restricted

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11
Q

what clinical features of osteoarthritis are seen in the spine

A

cervial- pain and restriction of neck movement

lumbar- pain on standing/ walking, spinal stenosis, pinch spinal nerves (neuralgic pain)

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12
Q

what is seen radiologically in osteoarthritis

A

loss of joint space, subchondral sclerosis, subchondral cysts, osteophytes

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13
Q

what is an osteophyte

A

a bony projection associated with the degeneration of cartilage at joints

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14
Q

what is the kellgren-lawrence grading scale

A

grades severity of osteoarthritis by radiological findings (osteophytes, joint space, subchondral sclerosis)

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15
Q

what is the non pharmacological management of osteoarthritis

A 
explanation 
physiotherapy (muscle strengthening, proprioceptive)
weight loss
exercise
trainers
walking sticks 
insoles

surgical, arthroscopic washout, loose body, soft tissue trimming, joint replacement

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16
Q

what is the pharmacologic management of osteoarthritis

A

analgesia- paracetamol, compound analgesics, topical analgesia
NSAIDs-topical/ systemic, may give additional symptomatic relief, consider risk/benefit ratio
pain modulators
intra-articular- steroids

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17
Q

what is gout

A

inflammation in the joint triggered uric acid crystals

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18
Q

what is the normal level of uric acid

A

> 0.42 mmol/l- over this becomes saturates- crystals form

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19
Q

what can cause hyperuricaemia

A

excess consumption of purine;

  • red meat
  • seafood
  • corn syrup
over production of urate:
-inherited enzyme defects 
-psoriasis
haemolytic disorders
-alcohol

under excretion;

  • chronic renal impairment
  • volume depletion
  • hypothyroidism
  • diuretics
  • cytotoxics
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20
Q

who gets gout more

A

men

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21
Q

acute gout is usually monoarthopathy- what does this mean

A

one joint affected- 1st MTP>ankle>knee

22
Q

what is the path of acute gout

A

abrupt onset, often overnight

settles in 3 days with treatment, 10 days without

23
Q

what is chronic tophaceous gout

A

chronic joint inflammation

often diuretic associated, high serum uric acid

tophi (lumps)

may get acute attacks

24
Q

what investigation can be done into gout

A

raised inflammatory markers

serum uric acid raised (may be normal during acute attack)

synovial fluid (polarising microscopy shows needle shaped negatively birefringent crystals)

renal impairment (may be cause of effect)

x rays (shows moss, haze= tophi)

25
Q

what is the treatment for acute gout

A

NSAIDs
colchicine
steroids

26
Q

what is the prophylaxis treatment for gout

A

allopurinol and febuxostat (reduce uric acid production)

27
Q

what does calcium pyrophosphate depostion disease

A

affects fibrocartilage (knees, wrists, ankles)

28
Q

what are the two types of calcium pyrophosphate deposition disease

A

calcium pyrophosphate (pseudogout) and calcium hydroxy appatite crystals

29
Q

describe calcium pyrophosphate crystals

A

envelope shaped, mildly positive birefringent

30
Q

what is seen to be markely raised in pseudogout

A

inflammatory markers

31
Q

what is CPPD (psuedogout) associated with

A 
hyperparathyriodism
gout
aging 
neuropathic joints 
trauma
32
Q

what is the treatment for pseudogout

A

NSAIDs
colchicine
steroids
rehydration

33
Q

what is milwaukee shoulder

A

common sign of hydroxyapatite crystal deposition in or around the joint

34
Q

what is released in hydroxyapatite crytal deposition

A

collagenases, serine proteinases and IL-1

35
Q

who gets hydroxyapatite and what is the onset like

A

females 50-60 years

acute and rapid deterioration

36
Q

what is the treatment for hydroxyapatite

A

NSAIDs
intra-articular steroid injection
physiotherapy
partial or total arthroplasty

37
Q

what is soft tissue rheumatism

A

pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerve near a joint rather than bone or cartilage

38
Q

what is the pain of soft tissue rheumatism like

A

confined to a specific site e.g. shoulder, wrist

39
Q

describe sift tissue rheumatism in the neck

A

muscular, usually self limiting

40
Q

where is the commonest area for soft tissue rheumatism

A

shoulder

41
Q

what are the causes of soft tissue rheumatism in the shoulder and sites affected

A 
adhesive capulitis 
rotator cuff tendinosis 
calcific tendonitis 
impingement 
partial rotator cuff tear 
full rotator cuff tears
42
Q

name causes of elbow soft tissue rheumatism and sites affected

A

medial and lateral epicondylitis- cubital tunnel syndrome

43
Q

name causes of wrist soft tissue rheumatism and sites affected

A

de-quervains tenosynovitis - carpal tunnel syndrome

44
Q

name causes of pelvis soft tissue rheumatism and sites affected

A

trochanteric, iliopsoas, ischiogluteal - bursitis and stress enthesopathies

45
Q

what part of foot can be affect by soft tissue rhemuatism

A

plantar fascitis

46
Q

what investigations can be done into soft tissue rheumatism

A

x ray- calcific tendonitis

MRI if fails to settle

47
Q

what is the treatment for soft tissue rheumatism

A 
pain control 
rest and ice compressions 
Physical therapy 
steroid injections
surgery
48
Q

who gets joint hypermobilty syndrome

A

females more than men, presents in childhood or 3rd decade

49
Q

what are signs of hypermobility in the beighton score

A

> 10 degrees hyperextension of the elbows

touching the fore arm with the thumb while flexing the wrist

passive extension of the fingers or a 90 degrees or more extension of the fifth finger

knee hyperextension (>10 degrees)

touching the floor with the palms of the hands when reaching down without the bending of the knees

50
Q

what might hypermobility present with or cause later in life

A

present with arthalgia

premature osteoarthritis

51
Q

what is the treatment for hypermobility

A

physiotherapy, explanation

52
Q

what can differentiate between RA and OA with history

A

x ray

msk (71 decks)

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