Rheum Flashcards
Pagets disease
Disorder of bone turnover - excessive formation and reabsorption of bone. Excess osteoclast + osteoblast activity. Malcoordinated -> sclerosis/lysis.
Enlarged and misshapen bones
Incresaed risk of path fractures
Affects head and spine
Features
elderly bone pain deformity fractures hearing loss
Ix
XR bone - Enlarged/deformed bones.
osteoporosis circumscripta - well defined osteolytic lesions - less dense than normal bone.
Cotton wool skull - patchy sclerosis, lysis
V shape defects in long bones. - osteolytic lesion surrounded by normal bone.
Bloods: Raised ALP. Ca and pi normal
Mx
Bisphosphonates: interfere with osteoclast activity
restore bone metabolism.
NSAIDs.
Ca and vit D supplemetns (whilst on bisphosphonates)
Monitoring: serum ALP, symptoms.
Complications: Osteogenic sarcoma - poor prognosis - increased focal bone pain, swelling, fractures.
Spinal stenosis / spinal cord compression
- Deformity -> narrowing of spinal canal. -> presses on spinal nerves -> neuro signs. MRI scan. Bisphosphonates tx. Neurosurg if severe.
pencil in cup apearance
psoriatic arthritis
XR features Ank SPon
Sacroiliitis: subchondral erosions, sclerosis.
Squaring of lumbar vertebrae.
Bamboo spine (late/uncommon)
Syndesmophytes - ossification of outer fibres of annulus fibrous
CXR: apical fibrosis
Mx Ank SPond
Ix: ESR, CRP, HLA B27 - although also in 10% normal population.
XR.
MRI
Encourage regular exercise NSAIDS Physio Sulfasalazine peristent high disease activity : etanercep/adalimumab.
osteogenesis imperfecta
AD bone fragility blue sclera deafness Normal PtH, Ca, ALP, Po4
sunburst appearance
metaphysis
child/adolescent
Osteosarcoma
cartilage capped bony projection
teenage boy
osteochondroma
25M
Epiphysis of femur
Double/soap bubble XR
Giant cell tumour
Pelvis cartilage growing lump
50M
Chondrosarcoma
13M
Growing lump posterior arm
XR: onion skin diaphysis lytic lesion
ewings sarcoma
FNA- EWSFLI1
