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Rheumatology/MSK > The normal joint and MSK symptoms > Flashcards

The normal joint and MSK symptoms Flashcards

1
Q

How common are MSK presentations in primary care?

A

About 1 in 5 consultations in primary care are about MSK problems

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2
Q

What are the most common presenting symptoms of joint disease?

A

Pain, stiffness and swelling - either localised to one joint or affecting multiple joints

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3
Q

How many types of joint are there?

A

Three

Fibrous, fibrocartilaginous and synovial

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4
Q

What are examples of fibrous and fibrocartilaginous joints?

A

The intervertebral discs, the SIJs, the pubic symphysis and the costochondral joints
There is little movement in these joints

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5
Q

What are examples of synovial joints?

A

Joints where there is a ball and socket e.g. hip
and hinge joints e.g. interphalangeal

In synovial joints, the opposed cartilaginous articular surfaces move painlessly over each other
Stability is maintained during use and the load is distributed across the surface of the joint

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6
Q

What is arthralgia?

A

Pain in joints when the joint appears normal on examination

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7
Q

In a patient presenting with joint pains, what is important to ask & do?

A

History:
Ask about joints affected - symmetrical, axial or peripheral?
Presence of morning stiffness - >30minutes in inflammatory arthropathies
Aggravating and relieving factors
PMHx
and FHx

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8
Q

What can be causes of joint pain?

A

Articular - pain from joint itself

Periarticular pain - from enthesitis, bursitis and tendinitis

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9
Q

What is enthesitis?

A

Inflammation at the site of attachment of ligaments, tendons and joint capsules

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10
Q

What are the causes of large joint monoarthritis?

A 
Osteoarthritis
Gout
Pseudogout
Septic arthritis 
Trauma
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11
Q

What could be a cause of acute non-traumatic monoarthritis or oligoarthritis in young people?

A

Reactive arthritis

Caused by disseminated gonococcal infection

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12
Q

Why does acute monoarthritis warrant urgent investigation and treatment?

A

To rule out septic arthritis

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13
Q

What is the key investigation in acute monoarthritis?

A

Synovial fluid aspiration with Gram stain and culture

& analysis for crystals in polarised light (in gout & pseudogout)

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14
Q

What is important to establish if the patient presents with stiffness?

A

Is it localised or generalised?
Does it affect limb girdles or periphery?
Is it worse in the morning or after activity?

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15
Q

What is the joint capsule?

A

It protects the joint - connects to the periosteum and is lined by synovium

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16
Q

What is synovial fluid?

A

viscous fluid that lubricates the joint secreted by synovial cells into the synovial cavity

17
Q

What is articular cartilage?

A

Cartilage on the faces of articulating surfaces

Hyaline cartilage - made up of water, type II collagen and proteoglycans

18
Q

What is the enthesis?

A

The point at which ligaments and tendons (both of which stabilise the joint) insert into bone

19
Q

What is the purpose of the anatomy and physiology of a synovial joint?

A

It creates a smooth, highly compressible structure which acts as a shock absorber and distributes load over the joint surface

20
Q

What is arthritis?

A

The term used when there is objective evidence of joint inflammation - swelling, deformity or an effusion

21
Q

What are less common causes of acute non-traumatic monoarthritis or oligoarthritis in young adults?

A

Rheumatoid arthritis
Spondyloarthropathies
TB infection and
Haemoarthrosis (in haemophilia or on warfarin)

22
Q

What are the most common causes of polyarticular arthritis in young males in the UK?

A

Reactive arthritis

Ankylosing spondylitis

23
Q

What are the most common causes of polyarticular arthritis in young adults in the UK?

A

Psoriatic arthropathy
Enteropathic arthropathy
Reactive arthritis

24
Q

What are the most common causes of polyarticular arthritis in young women in the UK

A

Systemic lupus erythematous
Rheumatoid arthritis
Sjogren’s syndrome

25
Q

What is the most common cause of polyarticular arthritis in middle-aged men in the UK?

A

Gout

26
Q

What is the most common cause of polyarticular arthritis in middle-aged women in the UK?

A

Rheumatoid arthritis

27
Q

What is the most common cause of polyarticular arthritis in middle-aged men and women in the UK?

A

Osteoarthritis

28
Q

What are the most common causes of polyarticular arthritis in the elderly in the UK?

A

Osteoarthritis
Polymyalgia rheumatica
Pseudogout

29
Q

What are causes of polyarticular arthritis in any age?

A 
Lyme disease
Endocarditis
Acute hepatitis B infection
HIV infection
Parovirus
30
Q

What are uncommon arthropathies?

A

Malignancy (hypertrophic pulmonary osteoarthropathy)
Rheumatic fever
Henoch-Schonlein purpura
Behcet’s syndrome

Rheumatology/MSK (6 decks)

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