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Module 204 MSK & Immune system > T2 L13 Intro to diseases of MSK system > Flashcards

T2 L13 Intro to diseases of MSK system Flashcards

1
Q

What is bursitis?

A

Inflammation of bursa

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2
Q

What are bursa?

A

Synovial membrane-lined pockets that allow free movement of adjacent structures to prevent friction

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3
Q

What is enthesitis?

A

Inflammation of enthesis

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4
Q

What are enthesis?

A

Points where tendons, ligaments or joint capsules insert into bone

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5
Q

What is osteoporosis?

A

Reduced bone density

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6
Q

What is osteomalacia?

A

Poor bone mineralisation

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7
Q

What is osteomyelitis?

A

Bone infection

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8
Q

What is oestosarcoma?

A

Example of malignant bone tumour

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9
Q

What is myositis?

A

Inflammation in muscle

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10
Q

What is myalgia commonly associated with?

A

Viral infections

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11
Q

What is monoarthritis?

A

Arthritis affecting 1 joint

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12
Q

What is oligoarthritis?

A

Arthritis affecting ≤ 4 joints but more than 1

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13
Q

What is polyarthritis?

A

Arthritis affecting ≥5 joints

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14
Q

How can rheumatic disease be classified?

A

Articular vs non-articular / periarticular
Inflammatory vs non-inflammatory
Number of joints affected
Duration of onset

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15
Q

What is periarticular joint pain?

A

Point tenderness over involved structure
Pain reproduced by movement involving that structure
Possible structures: bursa, tendon, tendon sheath, ligaments, others

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16
Q

What is articular joint pain?

A

Joint-line tenderness

Pain at end range of movement in any direction

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17
Q

How can inflammatory and mechanical causes be differentiated?

A

Signs of inflammation
Features of mechanical problem
Locking, catching etc

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18
Q

What are soft tissue conditions?

A

Problems with radiolucent moving tissues

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19
Q

What are examples of soft tissue conditions?

A

Tennis elbow
Golfers elbow
Carpal tunnel

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20
Q

What is tennis elbow?

A

Lateral epicondylitis

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21
Q

What is golfers elbow?

A

Medial epicondylitis

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22
Q

What is carpal tunnel?

A

Median nerve compression as it passes through carpal tunnel in wrist

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23
Q

What are the most common forms of arthritis in the UK?

A

Osteoarthritis

Rheumatoid arthritis

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24
Q

What is the prevalence of osteoarthritis and rheumatoid arthritis expected to continue rising?

A

Obesity
Sedentary lifestyle
Ageing population

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25
Q

How much is spent in the UK on treating MSK conditions?

A

£10 billion

26
Q

What should be considered in patient with single, hot and swollen joint?

A

Septic arthritis

27
Q

What is the mortality rate of septic arthritis?

A

11%

Increases to 50% in polyarticular disease with sepsis

28
Q

What are the most common organisms that cause septic arthritis?

A

Staph

Strep

29
Q

What is gout?

A

Monosodium urate crystals form and deposit in cartilage, bone and periarticular tissue of peripheral joints
Serum rate levels above physiological saturation point (408umol/L)

30
Q

What are the causes of gout?

A

Negative birefringent rods of monosodium urate

Pseudogout by positively birefringent rods of calcium pyrophosphate

31
Q

Describe the prevalence of gout

A

Men ≥40
Women ≥65
1 in 40 adults

32
Q

What are the risk factors for gout?

A 
Male sex
Older age
Metabolic syndrome - obesity, hypertension, hyperlipidaemia
Loop and thiazide diuretics
Genetic factors
Osteoarthritis
Chronic kidney disease
Dietary factors
33
Q

What is the management of an acute attack of gout?

A

NSAIDs e.g. naproxen
Colchicine
Steroids

34
Q

What is the management for long-term management of gout?

A

Urate-lowering therapy e.g. allopurinol or febuxostat

35
Q

What is rheumatoid arthritis?

A

Chronic multisystem inflammatory condition

36
Q

How common is rheumatoid arthritis?

A

Affects 0.5-1% of worlds population

More common in women

37
Q

What age is the peak onset of rheumatoid arthritis?

A

45-65 years

38
Q

What is a major risk factor for rheumatoid arthritis?

A

Smoking

39
Q

What is the pathophysiology of rheumatoid arthritis?

A

1) Early lymphocyte invasion of synovium
2) Acute inflammatory response - swelling and increased vascular permeability
3) Synovial proliferation
4) Pannus formation
5) Cartilage destruction and bone erosion

40
Q

What are the symptoms of rheumatoid arthritis?

A

Symmetrical pain and boggy swelling of small joints of hands and feet (MCP, PIP, Wrist, MTP, Subtalar)
Not DIP

41
Q

What are the extra- articular manifestations in rheumatoid arthritis?

A 
Nodules
Bursitis / tendosynovitis
Dry eyes
Splenomegaly
Anaemia of chronic disease
Lung fibrosis
Pericarditis
Leg ulcers
Neurological
Renal amyloidosis
Vasculitis
Increased risk CVD
42
Q

What investigations should be done in rheumatoid arthritis?

A 
ESR, CRP
FBC,
Rheumatoid factor positive 
Anti-CCP antibodies
X-rays
43
Q

Describe the X-ray findings in rheumatoid arthritis

A

Normal in early disease
Erosions / peri-articular osteoporosis
Reduced joint space / cysts

44
Q

What is the management of rheumatoid arthritis?

A 
Early and aggressive treatment to reduce inflammation and joint damage
NSAIDs
Corticosteroids 
DMARDs
Biologic agents
MDT input
45
Q

Give examples of synthetic DMARDs used in rheumatoid arthritis

A

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide

46
Q

Give examples of biologic agents used in rheumatoid arthritis

A 
Anti-TNF agents (etanercept, adalimumab)
Anti-B cell (rituximab)
Anti-IL6- receptor blocker (tocilizumab)
Anti-T cell selective co-stimulation modulator (abatacept)
JAK2 inhibitor (tofacitinib)
47
Q

What is osteoarthritis?

A

Degenerative disease characterised by joint pain and variable degrees of functional limitation

48
Q

What joints are most commonly affected in osteoarthritis?

A

Distal interphalangeal
Proximal interphalangeal
1st carpometacarpal joint

49
Q

What is the pathophysiology of osteoarthritis?

A

1) Metabolically active dynamic process involving all joint tissues (cartilage, bone, synovial, capsule, ligaments / muscles)
2) Focal destruction of articular cartilage
3) Remodelling of adjacent bone - hypertrophic reaction at joint margins)
4) Remodelling and repair process
5) Secondary synovial inflammation and crystal deposition

50
Q

What are the clinical features of osteoarthritis?

A

Morning stiffness lasting less than 30min
Persistent joint pain that is aggravated on use
Crepitus
No inflammation
Bony enlargement and/or tenderness

51
Q

What is systemic lupus erythematosus?

A

Chronic, relapsing remitting disease

Broad spectrum clinical features involving almost all organs and tissues

52
Q

What is the prevalence of SLE?

A

97 per 10,000 in UK
Female: male is 10-20:1
Peak onset is 15-40 years
More common in Afro-Caribbean, India, Hispanic and Chinese

53
Q

What is the pathophysiology of SLE?

A

1) Genes and environment
2) Abnormal immune response
3) Autoantibodies immune complex
4) Inflammation - rash, nephritis, arthritis, leukopenia, CNS disorder, clotting
5) Damage - renal failure, atherosclerosis, pulmonary fibrosis, stroke

54
Q

What are the genes involved in SLE?

A 
C1q, C2, C4
HLA-D2,3,8
MBL
FcR 2A, 3A, 2B
IL-10
MCP-1
PTPN22
55
Q

What are the signs and symptoms of SLE?

A 
Skin - malar rash, discoid rash
CNS - neurological damage, affective disorder
Lung - inflammation
Spleen - splenomegaly
Joints - arthritis
Kidney - glomerulonephritis
Serum - antinuclear antibodies
Blood - IFN signature, anaemia, thrombocytopenia
56
Q

What investigations should be done in SLE?

A 
Urinalysis
FBC
Urea and electrolytes
ESR
CRP
Liver function test
Antibodies - ANA, ENA, anti-dsDNA, lupus anticoagulant
C3, C4
57
Q

What is the non-pharmacological management of SLE?

A

Sun protecting
Smoking cessation
CVD risk modification
Osteoporosis prevention

58
Q

How is rheumatoid arthritis different to osteoarthritis?

A 
Synovial disease
Affects MCPs & PIPs instead of DIPs and 1st CMCJ
Stiffness in morning for more than 30min
Less stiff after activity
Raised inflammatory markers
Extra-articular features
Autoimmune
59
Q

How is rheumatoid arthritis the same as osteoarthritis?

A

Both are bilateral and symmetrical

Both have family history

60
Q

When is osteoarthritis worse?

A

On exertion and at end of day

Module 204 MSK & Immune system (44 decks)

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