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msk > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

what is osteoarthritis

A

a chronic disease characterised by cartilage loss and accompanying periarticular change

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2
Q

key pathological changes of OA

A

localised loss of hyaline cartilage and remodelling of adjacent bone with new bone formation at joint margins

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3
Q

what triggers the need to repair

A

a variety of joint traumas

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4
Q

risk factors for OA

A 
genetic factors
ageing
female sex
obesity
joint injury
occupational usage 
reduced muscle strength 
joint laxity
joint malignancy
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5
Q

what joints does localised OA affect

A

hips, knees, finger, facet joints of lower cervical and lower lumbar spines

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6
Q

what joints does generalised OA affect

A

defined as OA at either the spinal or hand joints and in at least 2 other regions

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7
Q

what is the clinical marker for generalised osteoarthritis

A

the presence of multiple heberden’s nodes

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8
Q

what are heberdens nodes

A

boney swellings at fingers

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9
Q

what type of joints are affected by OA

A

synovial

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10
Q

OA presentation

A 
pain - worse with joint use
morning stiffness lasting less than 30 mins
inactivity gelling
instability
poor grip in thumb OA
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11
Q

examination features of OA

A
  • joint line tenderness
  • crepitus
  • bony swelling
  • deformity
  • limitation of motion
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12
Q

presentation of cervical spine OA

A

pain and restriction of movement

occipital headaches may occur

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13
Q

presentation of lumbar spine oa

A

osteophytes can cause spinal stenosis if they encroach on the spinal canal

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14
Q

diagnosis of OA

A

clinical history
plain X-rays
MRI scans
ultrasound scans

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15
Q

what would be seen on X-ray in OA

A

marginal osteophytes
joint space narrowing
subchondral sclerosis
subchondral cysts

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16
Q

management of osteoarthritis

A 
education
lifestyle management 
physiotherapy occupational therapy
analgesia
local intra-articular steroid injections
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17
Q

surgical management for OA

A

joint replacements

arthroscopic surgery to remove loose bodies

18
Q

what are crystal arthropathies

A

they are a diverse group of disorders characterised by the deposition of various minerals in joints and soft tissues leading to inflammation

19
Q

what is gout

A

a potentially disabling and erosive inflammatory arthritis caused by the deposition of monosodium urate crystals into joints and soft tissues

20
Q

causes of hyperuricaemia

A

increased urate production

reduced urate excretion

21
Q

what can cause increased urate production

A
  • inherited enzyme defects
  • myeloproliferative/lymphoproliferative disorders
  • psoriasis
  • haemolytic disorders
  • alcohol
  • high dietary purine intake
22
Q

causes of reduced urate excretion

A
  • chronic renal impairment
  • volume depletion
  • hypothyroidism
  • diuretics
  • cytotoxics
23
Q

presentation of acute gout

A

MTP joint - ankle, knee
settles in about 10 days without treatment - 3 days with treatment
abrupt onset, often overnight

24
Q

chronic tophaceous gout

A 
chronic joint inflammation
often diuretic associated 
high serum uric acid 
tophi
may get acute attacks
25
Q

gout investigations

A 
serum uric acid raised 
raised inflammatory markers
polarised microscopy of synovial fluid
renal impairment 
x-rays
26
Q

how do you treat acute gout

A

NSAIDs
colchicine
steroids

27
Q

preventative measures for gout

A
  • Xanthine oxidase inhibitors - allopurinol, febuxostat
  • uricosuric drugs - sulfinpyrazone, probenecid, benzbromarone
  • IL-1 inhibitors - canakinumab, start 2 weeks after acute attack, requires cover with NSAIDs
28
Q

what are the indications for prophylactic therapy

A

1) two or more attacks of gout in year despite lifestyle change
2) presence of gouty tophi or signs of chronic gouty arthritis
3) uric acid calculi
4) chronic renal impairment
5) heart failure where unable to stop diuretics
6) chemotherapy patients who develop gout

29
Q

what is the target uric acid level for gout

A

300-360umol/L

30
Q

what does calcium pyrophosphate deposition disease affect

A

fibrocartilage

-knees, wrists, ankles

31
Q

causes of CPPD

A 
ageing
osteoarthritis
hyperparathyroidims
gout
trauma
familial hypocalciuric hypercalcaemia 
hemochromatosis
hypomagnesemia
hypothyroidism
amyloidosis
32
Q

treatment for CPPD

A

NSAIDs
colchicine
steroids
rehydration

33
Q

what is hydroxyapatite

A

hydroxyapatite crystal deposition in or around the joint

release of collagenases, serine proteases and IL-1

34
Q

treatment for hydroxyapatite

A

NSAIDS
intra-articular steroid injection
physiotherapy
partial or total arthroplasty

35
Q

what is soft tissue rheumatism

A

general term to describe pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerve near a joint rather than bone or cartilage

36
Q

what is the commonest area for soft tissue pain

A

the shoulder

37
Q

investigations for soft tissue problems

A

X-ray - calcific tendonitis
MRI if fails to settle
identify precipitating factors

38
Q

management for soft tissue problems

A 
pain control
rest and ice compressions
PT
steroid injections
surgery
39
Q

symptoms of joint hypermobility

A 
join pain especially after exercise
joint stiffness
foot and ankle pain
neck and backache
frequent sprains and dislocations
thin stretchy skin
40
Q

what does the modified beighton score measure

A

hypermobility

41
Q

treatment for hypermobility

A
  • education
  • physiotherapy
  • analgesia
  • surgery not recommended

msk (45 decks)

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