T2 L13 Intro to diseases of MSK system Flashcards
What is bursitis?
Inflammation of bursa
What are bursa?
Synovial membrane-lined pockets that allow free movement of adjacent structures to prevent friction
What is enthesitis?
Inflammation of enthesis
What are enthesis?
Points where tendons, ligaments or joint capsules insert into bone
What is osteoporosis?
Reduced bone density
What is osteomalacia?
Poor bone mineralisation
What is osteomyelitis?
Bone infection
What is oestosarcoma?
Example of malignant bone tumour
What is myositis?
Inflammation in muscle
What is myalgia commonly associated with?
Viral infections
What is monoarthritis?
Arthritis affecting 1 joint
What is oligoarthritis?
Arthritis affecting ≤ 4 joints but more than 1
What is polyarthritis?
Arthritis affecting ≥5 joints
How can rheumatic disease be classified?
Articular vs non-articular / periarticular
Inflammatory vs non-inflammatory
Number of joints affected
Duration of onset
What is periarticular joint pain?
Point tenderness over involved structure
Pain reproduced by movement involving that structure
Possible structures: bursa, tendon, tendon sheath, ligaments, others
What is articular joint pain?
Joint-line tenderness
Pain at end range of movement in any direction
How can inflammatory and mechanical causes be differentiated?
Signs of inflammation
Features of mechanical problem
Locking, catching etc
What are soft tissue conditions?
Problems with radiolucent moving tissues
What are examples of soft tissue conditions?
Tennis elbow
Golfers elbow
Carpal tunnel
What is tennis elbow?
Lateral epicondylitis
What is golfers elbow?
Medial epicondylitis
What is carpal tunnel?
Median nerve compression as it passes through carpal tunnel in wrist
What are the most common forms of arthritis in the UK?
Osteoarthritis
Rheumatoid arthritis
What is the prevalence of osteoarthritis and rheumatoid arthritis expected to continue rising?
Obesity
Sedentary lifestyle
Ageing population
How much is spent in the UK on treating MSK conditions?
£10 billion
What should be considered in patient with single, hot and swollen joint?
Septic arthritis
What is the mortality rate of septic arthritis?
11%
Increases to 50% in polyarticular disease with sepsis
What are the most common organisms that cause septic arthritis?
Staph
Strep
What is gout?
Monosodium urate crystals form and deposit in cartilage, bone and periarticular tissue of peripheral joints
Serum rate levels above physiological saturation point (408umol/L)
What are the causes of gout?
Negative birefringent rods of monosodium urate
Pseudogout by positively birefringent rods of calcium pyrophosphate
Describe the prevalence of gout
Men ≥40
Women ≥65
1 in 40 adults
What are the risk factors for gout?
Male sex Older age Metabolic syndrome - obesity, hypertension, hyperlipidaemia Loop and thiazide diuretics Genetic factors Osteoarthritis Chronic kidney disease Dietary factors
What is the management of an acute attack of gout?
NSAIDs e.g. naproxen
Colchicine
Steroids
What is the management for long-term management of gout?
Urate-lowering therapy e.g. allopurinol or febuxostat
What is rheumatoid arthritis?
Chronic multisystem inflammatory condition
How common is rheumatoid arthritis?
Affects 0.5-1% of worlds population
More common in women
What age is the peak onset of rheumatoid arthritis?
45-65 years
What is a major risk factor for rheumatoid arthritis?
Smoking
What is the pathophysiology of rheumatoid arthritis?
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
What are the symptoms of rheumatoid arthritis?
Symmetrical pain and boggy swelling of small joints of hands and feet (MCP, PIP, Wrist, MTP, Subtalar)
Not DIP
What are the extra- articular manifestations in rheumatoid arthritis?
Nodules Bursitis / tendosynovitis Dry eyes Splenomegaly Anaemia of chronic disease Lung fibrosis Pericarditis Leg ulcers Neurological Renal amyloidosis Vasculitis Increased risk CVD
What investigations should be done in rheumatoid arthritis?
ESR, CRP FBC, Rheumatoid factor positive Anti-CCP antibodies X-rays
Describe the X-ray findings in rheumatoid arthritis
Normal in early disease
Erosions / peri-articular osteoporosis
Reduced joint space / cysts
What is the management of rheumatoid arthritis?
Early and aggressive treatment to reduce inflammation and joint damage NSAIDs Corticosteroids DMARDs Biologic agents MDT input
Give examples of synthetic DMARDs used in rheumatoid arthritis
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Give examples of biologic agents used in rheumatoid arthritis
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)
What is osteoarthritis?
Degenerative disease characterised by joint pain and variable degrees of functional limitation
What joints are most commonly affected in osteoarthritis?
Distal interphalangeal
Proximal interphalangeal
1st carpometacarpal joint
What is the pathophysiology of osteoarthritis?
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
What are the clinical features of osteoarthritis?
Morning stiffness lasting less than 30min
Persistent joint pain that is aggravated on use
Crepitus
No inflammation
Bony enlargement and/or tenderness
What is systemic lupus erythematosus?
Chronic, relapsing remitting disease
Broad spectrum clinical features involving almost all organs and tissues
What is the prevalence of SLE?
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
What is the pathophysiology of SLE?
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
What are the genes involved in SLE?
C1q, C2, C4 HLA-D2,3,8 MBL FcR 2A, 3A, 2B IL-10 MCP-1 PTPN22
What are the signs and symptoms of SLE?
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
What investigations should be done in SLE?
Urinalysis FBC Urea and electrolytes ESR CRP Liver function test Antibodies - ANA, ENA, anti-dsDNA, lupus anticoagulant C3, C4
What is the non-pharmacological management of SLE?
Sun protecting
Smoking cessation
CVD risk modification
Osteoporosis prevention
How is rheumatoid arthritis different to osteoarthritis?
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
How is rheumatoid arthritis the same as osteoarthritis?
Both are bilateral and symmetrical
Both have family history
When is osteoarthritis worse?
On exertion and at end of day
