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