RA & OA & GOUT Flashcards
anatomy of synoviol joint
what is the most common joint disease?
OA
name some types of arthritis?
- OA
- Post-traumatic
- Inflammatory (RA)
- scondary to childhood hip disease
Define Osteoarthritis, & what r the common areas in the body?
it is degenerative, chronic bone disease “wear & tear”>> progressive loss of articular cartilage and remodelling of the underlying bone.
it is a clinical syndrome of joint pain
- hips
- knees
- small joints of hands
pathogenesis of OA
the chondrocytes, which r important in mainting the articular cartilage has 2 activites which is kept in balance (see below).
The release of enzymes from these cells break down collagen and proteoglycans, destroying the articular cartilage.
The exposure of the underlying subchondral bone results in sclerosis, followed by reactive remodelling changes that lead to the formation of osteophytes and subchondral bone cysts. The joint space is progressively lostover time.
but in OA they mediate DEGREDATION more!
Aeitology
Primary > dunno
secondary > trauma, infiltrative disease or connective tissue diseases
risk factors (5)
- obesity
- female
- manual labor work
- FH
- AGE
DDx
inflammatory arthropathies ( rheumatoid arthritis)
crystal arthropathies (gout), septic arthritis, fractures, bursitis, or malignancy (primary or metastatic).
Joint specific differential diagnoses for osteoarthritis:
- Hand– De Quervain’s tenosynovitis, RA, and gout
- Hip – trochanteric bursitis, radiculopathy, spinal stenosis, or iliotibial band syndrome
- Knee– referred hip pain, meniscal or ligament tears, or chondromalacia patellae
causes of secondary osteoarthritis!
(vitamen C)
Trauma
• Previous joint disorders;
• Developmental Dysplasia of the Hip (DDH)
- Infection: Septic arthritis, Brucella, Tb
- Inflammatory: RA, AS
- Metabolic: Gout
- Haematologic: Haemophilia
- Endocrine: DM
Where does the patient complain in OA of the Hip joint?
-pain in the hip, gluteal, groin areas radiated to the knee
Clinical Features & examination
pain and stiffness in joints, worsened with activity* > relieved by rest.
Pain tends to worsen throughout the day
stiffness tends to improve.
EXAMINATION
INSPECT HANDS
Bouchard nodes (swelling of PIPJs)
Heberden nodes (swelling of DIPJs)
Fixed flexion deformity or varus malalignment in the knees.
Joint finding on xray
OA vs RA
OA
- *L** – loss of joint space
- O** – *osteophytes
- *S** – subchondral sclerosis
- *S** – subchondral cysts
RA
- *L** – loss of joint space
- *E** – erosions
- *S** – soft tissue swelling
- *S** – soft bones (osteopenia)
Explain the reason behind the findin on Xray fro OA
Loss of joint space> due to degredation of Articular cartilage
osteophytes> as bone gets damaged, new bones form around
subchondrial sclerosis> the function of the cartilage is to help transmit the forces of bone equally, when that is gone the exposure of the underlying bone compensates in thickening up causing sclerosis
subchondrial cysts (LATE) > as bone is being damaged w/ time, cavitation w/in the bone forms, and that fills us with cyst like fluid!
what do u call osteoarthritis of the hip joint?
Coxarthrosis
what is the age & speed of onset in RA vs OA
RA-happens at any age>>Rapid
OA-usually later in life>>Over year (Slow)
what does the joint cartilage consist of?
how is that changed in osteoarthritis?
The surface changes alter the distribution of the biochemical forces
u also get CHONDROCYTES CLONING! in ana attempt to restore articular cartilage
wtf? normal chondrocytes r fully differentiated and dont need to proliferate!
Management of OA
conservative, medical, surgical
- if fat> loose weight
- strengthening excersizes
- local heat or Ice
- joint supports and physio
Medical
simple analgesics and topical NSAIDS
intra-articular steroid injections
Surgical
- Osteotomy
- Arthrodesis (joint fusion)
- Arthroplasty
Explain the joint findings in OA and RA
What is GOUT?
what crystals do u see?
accumalation of Monosodium Urate crystals in joints
due to Hyperurecima
Negatively Birefringent crystals
- due to underexcretion of uric acid
- due to overproduction of uric acid
What is uric acid?
how does that lead to Gout?
the break down product of purines contain in DNA
Urate is created every day when our bodies break down purines.
Purines are chemicals that are naturally created in our body, but they are also present in certain foods.
It’s normal and healthy to have some urate in your bloodstream.
some ppl think its caused mainly from what we eat, but 3/4 of the urate comes from the breakdown of purines already exsisting our bodies.
so the main cause can be either
- ur kidneys r unable to get rid of it
- or ur body is just making too much purines for some reason
what could be the reason for increased Monosodium urate crystals?
Which areas does Gout mostly effect?
describe the symptoms?
when does the attack mostly occur?
what do u call pain in the MTP joint in GOUT?
Swollen, red, painful
after a meal or alcohol consumption ( cuz alcohol metabolites compete for the same excretion sites in the kidney as uric acid!
what is osteoporosis?
Types?
risk factors?
Bones become “porous”
decrease in bone mass!
- enhanced bone resorption relative to formation!*
- Type 1> occurs in postmenopausal women, & is due to INCREASE IN OSTEOCLAST #! as a result of estrogen withdrawl!*
- Type 2> occurs in elderly, due to attenuated osteoblast function.*
RISK FACTORS:
- -genetic*
- -low ca+ intake*
- -insufficient Ca+ absorption*
- -Excersize*
- -cigarette smoking*
what is perthes disease?
condition effecting the hip joint of chikdren
blood to head of femur is disrupted
rickets?
is osteomalacia but in children.
bc the epipheseal plate cannot caldify, long bone become abnormally long and widen
