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Family medicine > Disorders of motor activity > Flashcards

Disorders of motor activity Flashcards

1
Q

What is the most common form of arthritis?

A

Osteoarthritis. Prevalence increase w age. 1/3 adults > 60 demonstrate radiographic OA

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2
Q

What is the typical history of OA?

A
  • joint pain worse w activity
  • morning stiffness lasting no more than 30m
  • stiffness after periods of immobility
  • impairment or function
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3
Q

What is found on PE in OA?

A
  • bony swelling
  • crepitus
  • jointline tenderness
  • limitation of joint mobility
  • joint instability
  • periarticular muscle atrophy
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4
Q

What is primary OA?

A

Idiopathic, occurs in previously undamaged joints. Can be classified as localized (1-2 sites) or generalized (3 or more sites)

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5
Q

What is secondary OA?

A

Ass w well -recognized causes

  • Inflammatory arthritis eg RA, psoriatic
  • Crystal arthropathy eg gout, calcium pyrophosphate deposition disease
  • septic arthritis /TB
  • prior joint trauma or surgery
  • endocrinopathy eg acromegaly, hyperparathyroidism
  • metabolic disorder eg hemachromatosis, ochronosis
  • neuropathic arthropathy eg DM, tabes dorsalis
  • prior bone disease eg Pagets, osteonecrosis
  • hemophilia
  • cong. / development eg dysplasia, slipped femoral epiphysis, Marfan sd
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6
Q

What are the risk factors for OA?

A
  • Older age
  • Obesity
  • female gender
  • joints malalignment
  • occupational activity, kneeling, stooping
  • presence of hand OA
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7
Q

What is the clinical ACR clinical radiographic DX criteria for OA in the knee

A

Knee pain + osteophyte + at least 1 of the following

  • age > 50 y
  • stiffness < 30 min
  • crepitus
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8
Q

ACR criteria for OA in hip?

A

Hip pain and at least 2 of the following

  • ESR < 20 mm/h
  • radiographic femoral or acetabular osteophytes
  • radiographic joint space narrowing, superior / axial / and or medial
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9
Q

What is the incidence of RA?

A

Peak btw 35 - 50, but can happen from 20 y. Higher incidence in women, 3,6% lifetime risk ( 1,7% in men)

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10
Q

What are the systemic features of RA?

A
  • Fatigue
  • Malaise
  • Weight loss
  • Weakness
  • Low grade fever
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11
Q

What are the ACR/ EULAR criteria for RA

A
  • Definite RA is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative dx better explaining the synovitis, and achievement of a total score of 6 or greater of possible 10
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12
Q

How are the points counted in ACR/EULAR criteria for RA w joint involvement?

A

Joint involvement

  • 0pt for 1 large joint
  • 1 pt for 2-10 large joints
  • 2 pts for 1-3 small joints
  • 3 pts for 4-10 small joints
  • 5 pts for > 10 joints, at leas 1 small
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13
Q

How are the points counted in ACR/EULAR criteria for RA w serology?

A

0 pt w RF and ACPA
2 pt w RF or ACPA positive at low titer < 3 times ULN
3 pts w ACPA positive at high titer, > 3 ULN (upper limits than normal)

ACPA = anti citrullinated peptides antibody

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14
Q

How are the points counted in ACR/EULAR criteria for RA w duration of synovitis and acute phase reactants?

A

Duration:
0pt < 6w
1 pt > 6w

Acute phase reactants
0 puts if normal ESR/CRP
1 pt if abnormal ESR/CRP

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15
Q

What is ankylosing spondylitis? (AS)

A

Bekhterevs sykdom

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16
Q

What is prevalence of AS?

A

0,2-0,5% in the US. More often in women. Age of onset peaks at 2nd and 3rd decade of life. 80% experience sx before 30 y

17
Q

What are the new york clinical criteria of AS?

A
  • Low back pain and stiffness > 3 months that improves w exercise, but not relieved by rest
  • Limitation of motion of the lumbar spine in the sagittal (sideways) and frontal (forward and backward) planes
  • Limitation of chest expansion relative to normal values, correlated for age and sex
18
Q

What are the new you radiological criteria?

A
  • sacrolitis grade 2 bilaterally or grade 3-4 unilaterally or bilaterally
  • grades
    1. some blurring of joint margins
    2. minimal sclerosis w some erosions ( mild sacrolithis)
    3. severe erosions w widening of joint space +/- some ankylosis
    4. complete ankylosis
19
Q

When can you say that it is definite AS?

A

Radiological + 1 clinical criteria

20
Q

What are the spectrum og spondyloarthritis disorders?

A
  • Axial SpA: 1) Ankylosisng spondylitis 2) Nonradiographic ax-SpA
  • Peripheral SpA:
    1) Arthritis ass w inflammatory bowel disease
    2) Reactive arthritis
    3) Psoriatic arthritis
    4) Undifferentiated SpA
21
Q

What is the criteria for axial SpA ?

A
  • 3 or more months of back pain and age at onset < 45y
  • Sacrolitis on imaging + 1 or more SpA feature
    OR
    HLA- B27 + 2 or more other SpA features
22
Q

How can you see sacrolitis on imaging

A
  • Acute/ active inflammation on MRI highly suggestive of sacrolitis ass w SpA
  • Definite radiographic sacrolitis according to modified NY criteria
23
Q

What are the SpA features?

A

1) inflammatory back pain 2) enthesitis (heel) 3) dectylitis 4) Crohns /UC 5) family history w SpA 6) increased CRP 7) arthritis 8) uveitis 9) psoriasis 10) good response to NSAIDs 11) HLA - B27

24
Q

Prevalence of lower back pain

A

Affect 8-10/10 people at some time in life. Is 2nd (behind common cold) cause of lost work time. Most common disability in people under 45y. Serious causes are uncommon, < 1%

25
Q

What are the causes of lower back pain?

A
  • Muscle / tendon sprain
  • Degenerative disc disorder
  • Disc herniation
  • OA of spine
  • Axial spondyloarthritis
  • NPL tumors or metastasis
  • discitis
  • vertebral osteomyelitis
  • spondylodiscitis
  • compressive fracture
  • congenital malformations
26
Q

What is the Px in lower back pain ?

A
  • 60% recover in 1-3 w
  • 90% recover in 6-8w
  • 95% recover in 12w
27
Q

What is the (typical) cause in age 30-60?

A

Lumbar disc herniation, degenerative disc disorder and muscle and other soft tissue strain

28
Q

What is the (typical) cause in age > 60?

A

OA, compression fracture, metastasis

29
Q

What are the red flags for cauda equine sd?

A

1) Saddle (perianal/perineal) anesthesia or paresthesia (numbness around passage and/or genitals)
2) Bladder disturbance: inability to urinate / difficulty, loss of sensation when passing urine, inability to stop/ control urination, loss of full bladder sensation
3) Bowel disturbance: inability to stop a bowel movemnet, constipation, loss of sensation when passing stool
4) Sexual problems: inability to achieve an erection or ejaculate, loss of sensation during intercourse
5) Nerve root pain: severe or progressive deficit in the lower extremities

30
Q

What are the red flags of spinal fracture?

A
  • Sudden onset of severe central pain in the spine, which is relived by lying down
  • Major trauma such as road accident or fall from hight
  • Minor trauma such as strenuous lifting, in people w osteoporosis
  • Structural deformity of the spine
31
Q

What are the red flags of infection or cancer in spine?

A
  • Onset >50 y or < 20y
  • history of cancer
  • constitutional sx: fever, chills, unexplained weight loss
  • recent bacterial inf
  • immune suppression
  • IV drug abuse
  • pain that remains when supine, aching night time pain that disturb sleep
  • structural deformity of spine
32
Q

What are the red flags for spondyloarthropathy?

A
  • early morning stiffness lasting > 45/60 min
  • night pain
  • easier w movement, worse at rest
33
Q

Red flags suggesting risk of permanent damage to the compressed nerve

A
  • significant muscle weakness or wasting

- loss of tendon reflex

34
Q

What are the orange flags for back pain ?

A

Psychiatric sx.

  • clinical depression
  • personality disorder
35
Q

What are the yellow flags for back pain ?

A

Increased risk of having chronic back pain

  • Beliefs and judgement:
    1. Unhelpful beliefs about pain, indication of injury as uncontrollable or likely to worsen
    2. Expectations of poor tx outcome, catastrophisation, delayed return to work
  • Emotional response
    1. distress not meeting criteria for dx of mental disorder
    2. worry, fears, anxiety
  • Pain behavior
    1. avoidance of activities due to expectations of pain and possible rein jury
    2. over reliance on passive tx ( hotpacks, cold packs, analgesics)
36
Q

What are the blue flags of back pain?

A

Perceptions about relationship btw work and health

  • belief that work is stressful, excessively demanding and likely to cause further injury
  • belief that workplace supervisor and workmated are unsupportive
37
Q

What are the black flags of back pain ?

A

Context, environment, system obstacles

  • Conflict w insurance staff over injury claim
  • Overly supportive family and health care providors
  • heavy work w little opportunity to modify duties

Family medicine (14 decks)

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