Conditions Flashcards
(36 cards)
Osteoporosis Definition
Reduced bone mass per unit volume
Osteoporosis Risk Factors
-Smoking
-alcohol
-low calcium diet (esp as a child)
• Lack of weight bearing exercise in childhood and adolescence
• Vitamin D – it increases calcium transport
• Prevent hormone deficieny- breast, prostate, thyroid cancer and HRT
• Eating disorder
• Malabsorption- coeliac
Osteoporisis Pathophysiology
- Peak bone mass around 30 y.o and then gradual decrease
- Bone stimulated by PTH, Vit D, TH, interleukin 1
- Bone inhibited by oestrogen, androgens, progesterone, calcitonin
- 2.5% bone loss per year post menopausal, women lose 30-40% of peak bone mass in lifetime
Osteoporosis Scan Features
T score-
above 1 = normal
-1 to -2.5 = osteopenia
less the -2.5= osteoporosis
is severe if there is a fracture
Osteoporosis Medications (3)
-Biophosphonates (e.g Fosamax) increase osteoclastic apoptosis and inhibiting bone resorption
oSelective Oestrogen Receptor Modulators (SERMS), acts like oestrogen to slow l=bone loss and reduce # risk
oHRT- normalize oestrogen and slow bone loss
Osteomyelitis Definition
Infection of the bone due to progressive inflammatory destruction- Staphlococus aureus
Osteomyelitis Pathological phases (5)
o Inflammation- acute- increase of lymphocytes to medullary bone= increase in intraosseous pressure=pain
o Supparation- pus formation 48-72 hrs- pressure increase can burst through the periosteum into the surrounding ST
o Necrosis- amount of pressure impacts the endosteal blood supply= periosteal stripping=sequestration
o Formation of new bone- 10-14 days- perosteum lays down new bone- onvolucrum surrounds the sequestrum
o Resolution- antibiotic therapy and pressure release
Osteomyelitis SSx adults and children
In children-
• Often have ssx prior to radiographic evidence
• Malaise, pain, fever
• Often history of trauma
• Pseudoparalysis (late stage when they cant weight bear)
In adults- • Immuno-comprised or old • Bone tenderness • Limp or decreased function • Mm spasm or other soft tissue involvement (often initial symptom) • Pyrexia and malaise if it has spread
Osteoarthritis Definition
Inflammatory, progressive cartilage degeneration
Osteoarthritis causes
- Primary/idopathic- no obvious triggering factor (most common)
- Secondary- trauma, connective tissue disorder
Osteoarthritis pathophys
- Disease of the articular cartilage
- Articular cartilage contains chondrocytes to decrease friction, reduce tension and resist heavy compression
- Chrondrocyte damage (genetic/envri- age, stress, surgery, trauma, inflame)→ Proliferation→ secretion of MMP stimulated by inflame interleukin 1. Collagenase and Protease break down type 2 collagen→ Matric remodeling and degradation→ breakdown, cracking and erosion of cartilage
Osteoarthritis SSx and joint affected
• Women >40 y.o • Usually gradual and slow onset • Weight bearing joitns • Pain- o Stiffness in the morning that eases o Worst at the end of the day o Relieved by rest o Worse in the cold • Signs- o Bony enlargement o Crepitus o Restrited movement o Tenderness on palpation
Joints affected- • Distal (DIPS more common) (RA PIPS more often) • Proximal interphalangeal joints (PIPS) • 1st metacarpal-trapezium joint • 1st metatarsal phalangeal joint • Spine • Hips • Knee • AC
Osteoarthritis Radiological Findings
- Loss of joints space
- Osteophytic growth
- Subchondral bone cysts
- Subchondral sclerosis
- Asymetrical distribution
- Intra-articular loose bodies
- Articular deformity
- Vacuum phenomenon
- Decrease density
Osteoarthritis Managment
• Education • Slow release paracetamol • Correct risk factors (weight, injury, overuse) • Exercise • Manual therapy to address biomechanical compensati -joint replacement -NSAIS _immunomodulatory drugs
Ankolosing Spondylitis Definition
chronic inflammatory condition- HLA b27 gene
Ankolosing Spondlitis Pathophys
- Pannus layers over articular cartilage and inflammatory cells infiltrate synovium.
- Fibrous tissue replaces the bone and fibrocartilage to invade the bone
- Bone erosion repairs to form spurs
Ankolosing Spondylitis SSx
- Progressive, worsening LBP
- Stiff ache sacrum, buttocks, thigh
- Diminished chest expansion
- Worse in morning, evening and night
- Stiffness and rigid
Ankolosing Spndylitis Radiology Findings
- Squaring of vertebral bodies
- Subchondrol sclerosis
- Ossifications
- Syndesmophytes where ligaments insert= bony growth
- Fusion of facets, SIJ, CV joint
- Bamboo spine
Rheumatoid Arthritis Definition
Generalised connective tissue disorder
Rheumatoid Arthritis Pathophsy
Inflammation of synovium (oedema and effusion)
• Formation of pannus at the bare area that spreads over bone and cartilage
• Bone destruction as pannus erodes in bare area and into subchondral bone= subchondral cysts
Rheumatoid Arthritis SSx
• Females>males • Onset 20-60 • Periodic episodes • Joint pain • Swelling • Stiffness • Loss of function • Bilateral joint involment • MCP and PIPS Often affect the Cx
Systemic Lupus Erythematosus Definition
Auto-immune, connective tissue disease→ dysfunctional immune system→ overproduction of autoantibodies
SLE risk factors
- Genetic
- UV overexposure
- EBV
- Drug induced
- High Oestrogen
- OCP
- 1st trimester pregnancy
SLE pathophys
• T cells work with the B cells to make autoantibodies which are deposited into various areas e.g. joints and kidneys, leading to apoctosis (cell death) and that’s when symptoms occur
