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MSK > Osteoarthritis and Crystal Arthropathies > Flashcards

Osteoarthritis and Crystal Arthropathies Flashcards

1
Q

What is osteoarthritis?

A

progressive degenerative condition affecting joints due to gradual thinning of cartilage, loss of joint space and osteophyte formation

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2
Q

What type of collagen is cartilage made up?

A

collagen type 2

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3
Q

What happens during the OA disease process?

A

loss of matrix, release of cytokines and meixed metalloproteinases as well as prostaglandins by the chondrocytes

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4
Q

Why are osteophytes produced in OA?

A

fibrillation of the cartilage surface which is then attempted to be repaired resulting in osteophytes

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5
Q

What are the symptoms seen in OA?

A

grad onset; mechanical pain; crepitus on movement; stiffness (less than 30mins); bony swelling and deformity of joints; effusions and soft tissue swellings (synovial thickening)

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6
Q

What are the joints most commonly affected by OA?

A

neck; lower back; hips; base of thumb; ends of fingers; knees; base of big toe

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7
Q

What is seen in the hands during OA?

A

DP; PIP and 1st CMC joints affected. squaring of the thumb

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8
Q

What is a Heberden node?

A

bony enlargement at the DIP

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9
Q

What is a Bouchards node?

A

bony enlargement at the PIP

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10
Q

Where might hip pain in OA radiate to?

A

in the groin; knee; radiate from the lower back

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11
Q

Why might you get nervous pain in OA?

A

osteophytes in the spine may impinge on nerve root

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12
Q

What are the risk factors for OA?

A

age; female; occupation (heavy lifting etc); previous injury/joint abnormality; obesity; other underlying joint problems

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13
Q

What is seen on X-ray of OA?

A

joint space narrowing; subchondral sclerosis; bony cysts; osteophytes

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14
Q

What is seen on bloods in OA?

A

nothing- inflam markers normal

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15
Q

What are the non-pharma managment for OA?

A

education; PT; wt loss; footwear; aids

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16
Q

What are the pharma options for OA?

A

analgesia; NSAIDs; pain modulators eg tricyclics gabapentin; intra-articular steroids (only short term)

17
Q

What crystals cause gout?

A

monosodium urate

18
Q

What crystals cause pseudogout?

A

calcium pyrophosphate dihydrate

19
Q

What is gout?

A

inflammatory arthritis assoc. with monosodium urate crystal deposition

20
Q

Who is gout seen in?

A

most common inflam arthritis in men
more common in men
increases with age

21
Q

What is hyperuricaemia defined as?

A

serum uric acid >7mg/dL

22
Q

What is the pathophysiology of gout?

A

overproduction and/or underexcretion of uric acid

23
Q

What can cause underexcretion of uric acid?

A

renal insufficiency; starvation; dehydration; hypothyroid;drug

24
Q

What is the presentation of acute monoarticular gout?

A

rapid onset; red, hot joint; severe pain; duration- up to 2 weeks; site- 1st MTPJ>ankle>knee> upper limb> spine

25
Q

What is the differential diagnosis of gout?

A

septic arthritis; trauma; seronegatvie arthritis

26
Q

What is seen with chronic polyarticular gout?

A

chronic joint inflam; tophi after recurrent acute attacks

27
Q

What is seen on bloods of acute gout?

A

inflam markers raised; raised WCC

28
Q

What is seen on x-ray of acute gout?

A

chronic/repeated attacks- erosions, overhanging osteophytes, joint destruction

29
Q

What is the gold standard for diagnosing gout?

A

joint aspiration

30
Q

What is seen in the joint aspirate?

A

needle-shaped crystals, negative birefringence on polarised light microscopy

31
Q

What is given in the managemnt of gout?

A

NSAIDs
colchicine
steroids

32
Q

What are the lifestyle modifications for gout?

A

restrict red meat; offal beans; shellfish

reduce alcohol; lost weight; lots of fluids- but not fizzy drinks with fructose (can be metabolised to purine)

33
Q

What are the indications for gout prophylaxis?

A

> 2 attacks; tophi; erosions on xray; renal stones

34
Q

What are the urate lowering therapy?

A

allopurinol/ febuxostat

35
Q

What are the crystals seen in pseudogout?

A

rhomboid/envelope shaped crystals with weakly positive birefringence

36
Q

What are the treatments for pseudogout?

A

NSAIDs; colchicine; steroids; rehydration

37
Q

What is hydroxyapatite?

A

milwaukee shoulder

38
Q

What is milwaukee shoulder caused by?

A

hydroxyapatite crystal deposition in or around the joint- shoulder

39
Q

Who is hydroxyapatite?

A

females, 50-60 years

MSK (39 decks)

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