ACT 1 - Rheumathology Flashcards
(82 cards)
Osteoporosis - definition
Bone weakening die to porous in bone
Osteoporosis - demografics
1 in 2 female above 50%
In male 1 in 5 - common as a secondary cause to another condition
Osteoporosis - Pathogenesis
Bone remodels through life
Peak bone density at 30, and then lose 1% a year. Women after menopause lose 2.5% a year.
Regulated by hormones
Osteoblast build bone (PTH, Vit. D, TH, interleukin)
Osteoclast reabsorbed bone (Estrogen, Progesterone, Calcitronin, Androgens)
Osteoporosis - Environmental Risk factors
smoking alcohol Calcium deficient diet lack of weight-bearing exercise Hormone deficiency Lack of Vit. D
Osteoporosis - Medical Risk Factors
- Eating disorder
- Malabsorption syndrome (Celiac)
- Chronic organ failure
- Prolonged immobilization
- Endocrine Disorder (cushions, Diabetes Mellitus, thyrotoxicosis)
Osteoporosis - Screening methods
DEXA - dual energy Xray - medicare rebate
Osteoporosis - medications
Biophosphonates - inhibit bone reabsortion
Selective Estrogen modulators - slow bone loss
Hormone replacement therapy - normalises oestrogen levels which slow down bone loss
Osteoporosis - Osteo treatment
Supervised resistance training Balance exercises
OT assessment at home
Gp medication review for dizziness Optomotrist for eye testing.
Increase: calcium, vitamin D levels
Decrease: smoking and alcohol
Osteomyelitis - definition
Bone infection - progressive inflammatory destruction of bone
Osteomyelitis - Demographics
Children
affects long bone and spine
Osteomyelitis - Cause
Staphylococus aureus – approx 80%
Gram – negative bacteria
Fungal infections in chronically ill Salmonella in Sickle Cell
Osteomyelitis - common infection sites
Long bones
Vertebra - Lx> Tx > Cx Radius
SIJ
Osteomyelitis - Pathophys - 5 phases
Blood borne bacterial spread
- Acute inflammatory inflammation
- Pus formation at bone periosteum
- Necrosis - sequestrum (segment of dead bone)
- Formation new bone (involcrum) to surround infection
- Resolution - anti biotic therapy and pressure release (surgery)
Osteomyelitis - classification
- spread from contiguous source - trauma/ post-surgery
- secondary osteomyelitis in patients with vascular insufficiency
Osteomyelitis - Clinical presentation kids
- Often present with symptoms prior radiograph evidence
- Often muted or covert symptoms
Malaise, pain, fatigue, - Often with history of trauma
- Pseudoparalysis
Osteomyelitis - Clinical presentation adults
- Usually immuno-compromised or elderly
- Bone tenderness
- Limp or decreased limb function
- Muscle spasm or other soft tissue involvement (this is often the initial symptom!)
- Pyrexia and malaise (if infection spread)
Osteomyelitis - diagnosis
difficult to diagnose MRI - children Biopsy raised ESP Radionucleide x-ray
Osteomyelitis - treatment
- immediate referral from osteo
- antibiotic
- drainage
- surgery
Osteoarthritis - demographic
40+
70+
obesity
Osteoarthritis -pathophys
Primary: disease of articular cartillage
Secondary: decrease friction of joints
resist tension
resist heavy compression
Osteoarthritis - Clinical presentation
Usually gradual and slow onset
Weightbearing joints
Pain
- Stiffness first thing in the morning that eases Pain worst at the end of the day
- Relieved by rest
- Worse with colder weather
Signs
- Bony enlargement Crepitus
- Restricted movement Tenderness on palpation
Osteoarthritis - Diagnosis
X-ray if changes treatment
Osteoarthritis - Radiological findings
Loss of joint space
Osteophytic growth Subchondral bone cyst Subchondral sclerosis
Asymmetrical distribution Intra-articular loose bodies Articular deformity
Vacuum phenomenon
Osteoarthritis - Management
Provide education and reassurance
Medication
- Slow-release paracetamol is the most common
Correct risk factors that are modifiable
Weight loss Injury Overuse
Exercise
Manual therapy to address biomechanical compensations Joint replacement
