Rheumatoid Arthritis, Gout and Avascular Necrosis Flashcards
What causes rheumatoid arthritis?
it has an unknown cause but has clear links with the immune system and a potential genetic link
What is the clinical picture of rheumatoid arthritis?
severe pain
swelling
deformity
commonly small joints of the hands and feet affected with symmetrical pattern
large joints are infrequent but also no symmetry
More common in women
What do patients with rheumatoid arthritis first notice symptom wise?
stiffness - particularly in the morning and then improves throughout the day
What is the role of surgery?
ensure comfort - RA is a primarily medically treated disease
What happens in soft tissue surgery for RA?
tendon sheaths and tendons can be damaged, and this can be halted sometimes by synovectomy. Occasionally tendons actually rupture and a repair is needed
What is an excision arthroplasty?
Some of the joint is removed which helps decrease pain but limits functionality
What is avascular necrosis?
Bone tissue death through loss of blood supply
What can cause avascular necrosis?
Trauma
unknown cause
What areas are particularly at risk to AVN?
femoral head
scaphoid
proximal talus
What is Caisson’s disease?
AVN in deep sea divers
What factors can cause AVN in strange circumstances?
chronic alcohol abuse
steroids
Caisson’s
How is AVN diagnosed?
difficult on x-ray until later when the bone becomes dense
sometimes it can revascularise normally but with some deformity
surgical blood supply restoration is not possible just now
How is AVN managed?
non-specific
rest
joint replacement salvage is all that can be done
What is gout?
Gout is a painful joint condition caused by urate crystal deposition into the joint typically in dehydration or after chemotherapy
what can cause gout?
dehydration
diuretics
chemotherapy
