Osteoarthritis, Crystal Arthritis and Soft Tissue Rheumatism

Question 1

what is osteoarthritis

Answer 1

articular cartilage thinning or loss

Question 2

what are the risk factors for osteoarthritis

Answer 2

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

Question 3

what can cause the pathogenesis caused osteoarthritis

Answer 3

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

Question 4

what are the two types of osteoarthritis

Answer 4

idiopathic and secondary

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

Question 5

what joints are affected by osteoarthritis

Answer 5

load bearing ones:

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

Question 6

what are the symptoms of osteoarthritis

Answer 6

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)

Question 7

what is seen on examination of a patent with osteoarthritis

Answer 7

crepitus (bone rubbing on bone)

joint swelling- bone enlargements due to osteophytes

joint tenderness

joint effusion (due to secondary inflammation within the joint)

Question 8

what clinical features of osteoarthritis are seen in the hands

Answer 8

DIP, PIP and 1st CMC joints affected

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

squaring of the hands

Question 9

what clinical features of osteoarthritis are seen in the knees

Answer 9

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)

Question 10

what clinical features of osteoarthritis are seen in the hip

Answer 10

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

hip movements restricted

Question 11

what clinical features of osteoarthritis are seen in the spine

Answer 11

cervial- pain and restriction of neck movement

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

Question 12

what is seen radiologically in osteoarthritis

Answer 12

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

Question 13

what is an osteophyte

Answer 13

a bony projection associated with the degeneration of cartilage at joints

Question 14

what is the kellgren-lawrence grading scale

Answer 14

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

Question 15

what is the non pharmacological management of osteoarthritis

Answer 15

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

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

Question 16

what is the pharmacologic management of osteoarthritis

Answer 16

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

Question 17

what is gout

Answer 17

inflammation in the joint triggered uric acid crystals

Question 18

what is the normal level of uric acid

Answer 18

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

Question 19

what can cause hyperuricaemia

Answer 19

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

Question 20

who gets gout more

Answer 20

men

Question 21

acute gout is usually monoarthopathy- what does this mean

Answer 21

one joint affected- 1st MTP>ankle>knee

Question 22

what is the path of acute gout

Answer 22

abrupt onset, often overnight

settles in 3 days with treatment, 10 days without

Question 23

what is chronic tophaceous gout

Answer 23

chronic joint inflammation

often diuretic associated, high serum uric acid

tophi (lumps)

may get acute attacks

Question 24

what investigation can be done into gout

Answer 24

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)

Question 25

what is the treatment for acute gout

Answer 25

NSAIDs colchicine steroids

Question 26

what is the prophylaxis treatment for gout

Answer 26

allopurinol and febuxostat (reduce uric acid production)

Question 27

what does calcium pyrophosphate depostion disease

Answer 27

affects fibrocartilage (knees, wrists, ankles)

Question 28

what are the two types of calcium pyrophosphate deposition disease

Answer 28

calcium pyrophosphate (pseudogout) and calcium hydroxy appatite crystals

Question 29

describe calcium pyrophosphate crystals

Answer 29

envelope shaped, mildly positive birefringent

Question 30

what is seen to be markely raised in pseudogout

Answer 30

inflammatory markers

Question 31

what is CPPD (psuedogout) associated with

Answer 31

``` hyperparathyriodism gout aging neuropathic joints trauma ```

Question 32

what is the treatment for pseudogout

Answer 32

NSAIDs colchicine steroids rehydration

Question 33

what is milwaukee shoulder

Answer 33

common sign of hydroxyapatite crystal deposition in or around the joint

Question 34

what is released in hydroxyapatite crytal deposition

Answer 34

collagenases, serine proteinases and IL-1

Question 35

who gets hydroxyapatite and what is the onset like

Answer 35

females 50-60 years acute and rapid deterioration

Question 36

what is the treatment for hydroxyapatite

Answer 36

NSAIDs intra-articular steroid injection physiotherapy partial or total arthroplasty

Question 37

what is soft tissue rheumatism

Answer 37

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

Question 38

what is the pain of soft tissue rheumatism like

Answer 38

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

Question 39

describe sift tissue rheumatism in the neck

Answer 39

muscular, usually self limiting

Question 40

where is the commonest area for soft tissue rheumatism

Answer 40

shoulder

Question 41

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

Answer 41

``` adhesive capulitis rotator cuff tendinosis calcific tendonitis impingement partial rotator cuff tear full rotator cuff tears ```

Question 42

name causes of elbow soft tissue rheumatism and sites affected

Answer 42

medial and lateral epicondylitis- cubital tunnel syndrome

Question 43

name causes of wrist soft tissue rheumatism and sites affected

Answer 43

de-quervains tenosynovitis - carpal tunnel syndrome

Question 44

name causes of pelvis soft tissue rheumatism and sites affected

Answer 44

trochanteric, iliopsoas, ischiogluteal - bursitis and stress enthesopathies

Question 45

what part of foot can be affect by soft tissue rhemuatism

Answer 45

plantar fascitis

Question 46

what investigations can be done into soft tissue rheumatism

Answer 46

x ray- calcific tendonitis MRI if fails to settle

Question 47

what is the treatment for soft tissue rheumatism

Answer 47

``` pain control rest and ice compressions Physical therapy steroid injections surgery ```

Question 48

who gets joint hypermobilty syndrome

Answer 48

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

Question 49

what are signs of hypermobility in the beighton score

Answer 49

>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

Question 50

what might hypermobility present with or cause later in life

Answer 50

present with arthalgia premature osteoarthritis

Question 51

what is the treatment for hypermobility

Answer 51

physiotherapy, explanation

Question 52

what can differentiate between RA and OA with history

Answer 52

x ray