Osteoarthritis, Crystal Arthritis and Soft Tissue Rheumatism Flashcards
what is osteoarthritis
articular cartilage thinning or loss
what are the risk factors for osteoarthritis
age, female, obesity, previous injury, occupation (farmers), sports activities, muscle weakness, proprioceptive defercts, genetic elements, acromegaly, joint inflammation, crystal deposition in cartilage
what can cause the pathogenesis caused osteoarthritis
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
what are the two types of osteoarthritis
idiopathic and secondary
secondary= previous injury =, calcium crystal deposition, rheumatoid arthritis
what joints are affected by osteoarthritis
load bearing ones:
- cervical spine
- lumbar spine
- hand (DIP, PIP, 1st IP, 1st MCP (1st thumb), CMC0
- hip
- knee
- foot (MTP)
what are the symptoms of osteoarthritis
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)
what is seen on examination of a patent with osteoarthritis
crepitus (bone rubbing on bone)
joint swelling- bone enlargements due to osteophytes
joint tenderness
joint effusion (due to secondary inflammation within the joint)
what clinical features of osteoarthritis are seen in the hands
DIP, PIP and 1st CMC joints affected
bony enlargements may be seen at DIPs (heberdens nodes) and PIPs (bouchards nodes)
squaring of the hands
what clinical features of osteoarthritis are seen in the knees
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)
what clinical features of osteoarthritis are seen in the hip
pain may be felt in groin or radiating to knee or radiating from the lower back
hip movements restricted
what clinical features of osteoarthritis are seen in the spine
cervial- pain and restriction of neck movement
lumbar- pain on standing/ walking, spinal stenosis, pinch spinal nerves (neuralgic pain)
what is seen radiologically in osteoarthritis
loss of joint space, subchondral sclerosis, subchondral cysts, osteophytes
what is an osteophyte
a bony projection associated with the degeneration of cartilage at joints
what is the kellgren-lawrence grading scale
grades severity of osteoarthritis by radiological findings (osteophytes, joint space, subchondral sclerosis)
what is the non pharmacological management of osteoarthritis
explanation physiotherapy (muscle strengthening, proprioceptive) weight loss exercise trainers walking sticks insoles
surgical, arthroscopic washout, loose body, soft tissue trimming, joint replacement
what is the pharmacologic management of osteoarthritis
analgesia- paracetamol, compound analgesics, topical analgesia
NSAIDs-topical/ systemic, may give additional symptomatic relief, consider risk/benefit ratio
pain modulators
intra-articular- steroids
what is gout
inflammation in the joint triggered uric acid crystals
what is the normal level of uric acid
> 0.42 mmol/l- over this becomes saturates- crystals form
what can cause hyperuricaemia
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
who gets gout more
men
acute gout is usually monoarthopathy- what does this mean
one joint affected- 1st MTP>ankle>knee
what is the path of acute gout
abrupt onset, often overnight
settles in 3 days with treatment, 10 days without
what is chronic tophaceous gout
chronic joint inflammation
often diuretic associated, high serum uric acid
tophi (lumps)
may get acute attacks
what investigation can be done into gout
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)
what is the treatment for acute gout
NSAIDs
colchicine
steroids
what is the prophylaxis treatment for gout
allopurinol and febuxostat (reduce uric acid production)
what does calcium pyrophosphate depostion disease
affects fibrocartilage (knees, wrists, ankles)
what are the two types of calcium pyrophosphate deposition disease
calcium pyrophosphate (pseudogout) and calcium hydroxy appatite crystals
describe calcium pyrophosphate crystals
envelope shaped, mildly positive birefringent
what is seen to be markely raised in pseudogout
inflammatory markers
what is CPPD (psuedogout) associated with
hyperparathyriodism gout aging neuropathic joints trauma
what is the treatment for pseudogout
NSAIDs
colchicine
steroids
rehydration
what is milwaukee shoulder
common sign of hydroxyapatite crystal deposition in or around the joint
what is released in hydroxyapatite crytal deposition
collagenases, serine proteinases and IL-1
who gets hydroxyapatite and what is the onset like
females 50-60 years
acute and rapid deterioration
what is the treatment for hydroxyapatite
NSAIDs
intra-articular steroid injection
physiotherapy
partial or total arthroplasty
what is soft tissue rheumatism
pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerve near a joint rather than bone or cartilage
what is the pain of soft tissue rheumatism like
confined to a specific site e.g. shoulder, wrist
describe sift tissue rheumatism in the neck
muscular, usually self limiting
where is the commonest area for soft tissue rheumatism
shoulder
what are the causes of soft tissue rheumatism in the shoulder and sites affected
adhesive capulitis rotator cuff tendinosis calcific tendonitis impingement partial rotator cuff tear full rotator cuff tears
name causes of elbow soft tissue rheumatism and sites affected
medial and lateral epicondylitis- cubital tunnel syndrome
name causes of wrist soft tissue rheumatism and sites affected
de-quervains tenosynovitis - carpal tunnel syndrome
name causes of pelvis soft tissue rheumatism and sites affected
trochanteric, iliopsoas, ischiogluteal - bursitis and stress enthesopathies
what part of foot can be affect by soft tissue rhemuatism
plantar fascitis
what investigations can be done into soft tissue rheumatism
x ray- calcific tendonitis
MRI if fails to settle
what is the treatment for soft tissue rheumatism
pain control rest and ice compressions Physical therapy steroid injections surgery
who gets joint hypermobilty syndrome
females more than men, presents in childhood or 3rd decade
what are signs of hypermobility in the beighton score
> 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
what might hypermobility present with or cause later in life
present with arthalgia
premature osteoarthritis
what is the treatment for hypermobility
physiotherapy, explanation
what can differentiate between RA and OA with history
x ray
