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ANKI Rheumatology > Paget's Disease > Flashcards

Paget's Disease Flashcards

1
Q

What are 25% of cases of Paget’s?

A

monostotic

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2
Q

What are 75% of cases of Paget’s?

A

polyostotic

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3
Q

What is the definition of Paget’s?

A

disorder of bone remodelling (i.e. formation and resorption) – genetic factors play a role

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4
Q

What are the 3 phases of Paget’s disease?

A
  1. Lytic phase
  2. Mixed phase
  3. Sclerotic phase
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5
Q

What happens in the lytic phase?

A

hyperactive osteoclasts leads to resorption

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6
Q

What happens in the mixed phase?

A

compensation by osteoblasts

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7
Q

What happens in the sclerotic phase?

A

hyperactive osteoblasts leads to formation (woven bone, not lamellar)

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8
Q

What are RF for Paget’s disease?

A
  • Elderly

* FHx

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9
Q

What are symptoms of Paget’s disease?

A
  1. Often asymptomatic
  2. Fragility fractures
  3. Bone pain (insidious onset)
    Skull, pelvis, femur
  4. Nerve compression
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10
Q

What does the nerve compression lead to?

A
  1. Hearing loss (sensorineural)

2. Sciatica

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11
Q

What are the signs of Paget’s disease?

A
  1. Bone enlargement/bossing

2. Warm skin over painful area (high metabolic activity)

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12
Q

What Ix are done?

A

• Physical examination (cardio/resp/abdo/neuro)
• Basic observations
• Bloods
- Imaging

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13
Q

What bloods are done?

A
  1. (FBC, CRP)
  2. U&E
  3. LFTs (ALP)
  4. Calcium
  5. Phosphate
  6. PTH
  7. Serum CTX (bone resorption marker)
  8. Serum P1NP (bone formation marker)
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14
Q

What are the key blood levels?

A

Calcium, phosphate, PTH normal but ALP high

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15
Q

What imaging is done?

A
  • X-rays

* Bone scan (Tec99)

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16
Q

What is in the bone scan?

A
  1. Hot spots = lytic areas

2. Tec99 is the tracer

17
Q

What are different imaging modalities used in Paget’s?

A
  1. X-ray e.g. CXR, DEXA
  2. CT e.g. CTPA
  3. MRI
  4. U/S e.g. echocardiograms
  5. Nuclear medicine e.g. bone scan, PET, thyroid uptake, V/Q scans
18
Q

What is the conservative management of Paget’s?

A

supportive with education, regular follow ups, preventive measures

19
Q

What is the medical management of Paget’s?

A

BISPHOSPHONATES (zoledronic acid 5mg infusion / alendronic acid 40mg OD 6/12) for symptomatic patients

ANKI Rheumatology (14 decks)

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