Week 137 - Arthritis/Gout Flashcards
What are the clinical features of Reactive Arthritis?
Acute, Asymmetrical, lower-limb arthritis
Occuring a few days/couple weeks after infection
Enthesitis is common
What type of arthritis is associated with IBD?
Enteropathic arthritis
Symmetrical + lower limbs
Occurs in 10-15% of pt with UC/Crohn’s
What is gout?
Inflammatory arthritis associated with hyperuricaemia
What do uricouric drugs block (e.g. probenecid)?
GLUT9 and URAT-1 = ↑excretion of uric acid in urine
What are the clinical features of acute gout?
Sudden onset + agonizing pain, swelling, redness of first MTP joint
Name two xanthine oxidase inhibitors
Allopurinol ( first line)
Febuxostat
What is chronic tophaceous gout?
Individuals with very high levels of uric acid can present with this
Sodium urate forms smooth white deposits (tophi) in skin
What is psedogout?
Calcium pyrophosphate deposits in hyaline and fibrocartilage
Crystals are shed resulting in acute synovitis which resembles gout
What are the clinical features of Septic Arthritis?
Joint hot, red, swollen
Agonizingly painful
Held immobile by muscle spasm
In 20% >1 joint affected
The hip joint is an articulation between…
Head of femur and acetabulum of hip
What muscles are responsible for flexion of the hip?
Iliopsoas
Rectus Femoris
Sartorius
Adductor muscles
What muscles are responsible for extension of the hip?
Gluteus maximus
Hamstring muscles
What muscles are responsible for abduction of the hip?
Gluteus medius Minimus Sartorius Tensor fascie latae Piriformis
What muscles are responsible for adduction of the hip?
Adductor longus & brevis
Adductor fibers of adductor magnus
Pectineus & gracilis
Hip joint pain can be referred to front+medial side of thigh, why?
Femoral nerve not only supplies the hip joint but also supplies medial + front of thigh
Why would hip joint disease sometimes give rise to pain in knee joint?
Posterior division of obturator nerve supplies both hip and knee joints
What are the four major routes by which structures pass from the abdomen into the lower limb?
Obturator canal
Greater Sciatic Foramen
Lesser Sciatic Foramen
Gap between inguinal ligament & pelvic bone
What structures pass through the greater sciatic foramen?
Split by piriformis muscle
Superior gluteal nerve & vessels
Inferior gluteal nerve & vessels, Sciatic Nerve, pudendal nerve, internal pudendal vessels
Femoral Nerve - Origin + Innervation
L2-L4
All muscles of anterior compartment of thigh
Obturator Nerve - Origin + Innervation
L2-L4
All muscles of medial compartment of thigh (except part of adductor magnus muscle)
Sciatic Nerve - Origin + Innervation
L4-S3 of sacral plexus
All muscles of posterior compartment of thigh
Nerve divides into common fibular nerve and tibial nerve
What does the Gluteal Nerve innervate?
Superior gluteal nerve
Inferior gluteal nerve
Lateral Cutaneous Nerve - Origin + Innervation
L2-L3
Supplies skin on lateral side of thigh
Nerve to quadratus femoris - Origin + Innervation
L4-S1
gemellus inferior + quadratus femoris
Nerve to obturator internus - Origin + Innervation
L5-S2
gemellus superior + obturator muscle
Name the myotomes and joint movements involved in “kicking down a door”
L2 - hip flexion
L3 - knee extension
L4 - ankle dorsi-flexion
Which myotome is tested during knee flexion?
S2
Which myotome is tested during ankle-plantar flexion/ankle eversion/hip extension?
S1
What are the clinical signs of tarsal tunnel syndrome?
Vague discomfort or pain (burning, tingling) in plantar foot
Prolonged standing & walking usually exacerbate the symptoms
?Night pain, improved with massage/walking
What are the clinical signs of peroneal nerve injury?
Paretic/Paralyzed ankle dorsiflexors (i.e. foot drop)
Loss of sensation
Tapping on nerve at fibular head -> may produce Tinnel’s sign
What are the features of osteoarthritis on X-ray?
Joint space narrowing
Sclerosis
Subchondral cysts
Osteophytes
Who do cartilage focal lesions most commonly affect?
Younger Sporty People
Either by repetitive or traumatic impact
Describe the grading of cartilage defects
Grade I - superficial cartilage
Grade II - 1/2 depth of cartilage
Grade III - down to subchondral bone
Grade IV - exposure of subchondral bone
What are the treatments available for cartilage damage?
Debridement
Microfracture
Autologous chondrocyte implantation (ACI)
What is Vitamin D made from?
7-Dehydrocholesterol (+ light)
What enzyme is stimulated in the kidney by PTH affecting the vitamin D levels?
1-α-hydroxylase
What effect does vitamin D have in the GUT?
↑transepithelial transport of Ca and PO4
↑serum [Ca]
What effect does vitamin D have in the BONE?
Stimulate terminal differentiation of OC
Directly + via OB
↑serum [Ca]
What effect does vitamin D have in the Parathyroid?
Inhibit PTH production
What effect does PTH have on the body?
↑Bone Resorption
↑Renal Tubular Reabsorption
↑1-α-hydroxylase
↑serum [Ca]
What is the effect of calcitonin?
↓OC bone resorption
What drugs decrease excretion of urate?
Aspirin (Low Dose)
Thiazine Diuretics
Furosemide
Ethambutol
What is an apophysis?
Separate growth centre/ossification centre
Forming a lump (e.g. greater trochanter)
When does the iliac crest growth plate fuse?
about 25 yrs
What is the difference between a stress fracture and insufficiency fracture?
Stress Fracture - repeated microtrauma on NORMAL bone
Insufficiency Fracture - NOT normal bone
What is Perthes’ disease?
Femoral head softens and breaks down due to avascular necrosis
