final - msk and rheum

Question 1

Objectives

Answer 1

• 1.) Identify common chronic and acute musculoskeletal and rheumatologic disorders.
• 2.) Detail appropriate laboratory and imaging modalities to diagnose musculoskeletal disorders.
• 3.). Describe pharmacologic and rehabilitative interventions to treat musculoskeletal disorder commonly encountered in the family practice setting.
• 4.). Demonstrate the process of escalating treatment including appropriate urgent and emergent referral patterns.

Question 2

Common acute MSK disorders

Answer 2

• Osteoarthritis
• Rheumatoid arthritis
• Gout
• Carpal Tunnel syndrome

Question 3

Risk Factors

Answer 3

• Risk Factorsion

Question 4

Clinical Diagnosis

Answer 4

• Joint Pain+ at least 3 of the following:
• Age >50 years
• Morning stiffness <30 min
• Crepitus
• Bony tenderness
• Bony enlargement
• No palpable warmth

Question 5

Physicial Exam

Answer 5

• • Joint tenderness
• • Crepitus (grinding sensation with movement)
• • Decreased range of motion
• • Bony enlargements (Heberden’s and Bouchard’s nodes in fingers)
• Joint swelling (usually non-inflammatory)

Question 6

History & Presentation

Answer 6

• • Symmetric joint pain and stiffness, often involving Small joints of hands (MCP, PIP), wrists, and feet
• • Morning stiffness > 1 hour, improves with movemetn
• • Symptoms last ≥ 6 weeks
• Fatigue, low-grade fever, and weight loss may also be present
• • Difficulty using hands for daily activities (e.g., buttoning clothes)
• • Systemic symptoms with unknown cause
• Starts between ages 30–60
• more often in females.

Question 7

Physical Exam

Answer 7

• • Joint swelling, warmth, and tenderness
• Especially in MCP, PIP, wrists and MTP joints
• • Symmetrical involvement of multiple joints
• Possible nodules, ulnar deviation, or joint deformities in advanced disease

Question 8

Classification of rA

Answer 8

• -Calcium pyrophosphate deposition disease-

Question 9

diagnosis

Answer 9

• You have pain and swelling in 3 or more joints.
• Arthritis has been present for longer than 6 weeks.
• You have a positive test for rheumatoid factor or anti-cyclic citrullinated peptide (anti-CCP) antibody.
• You have an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels.
• Other types of arthritis have been ruled out.

Question 10

Progression of the disease

Answer 10

• ACPA,anticyclic citrullinated peptide/protein antibodies; RA,rheumatoid arthritis.

Question 11

Non-Pharmacologic Treatments

Answer 11

• Main objective: reduce disability, improve function and enhance quality of life.
• 1. Physical and Occupational Therapy
• 2. Exercise and Lifestyle Modification (swimming, walking, cycling) reduces fatigue and improves mood, weight management , AVOID PROLONGED REST!!!!)
• 3. Nutrition and Diet ( Anti-inflammatory diet: Emphasize fruits, vegetables, whole grains, and omega-3 fatty acids (e.g., fish, flaxseeds)
• Avoid alcohol excess (especially with DMARD use)
• 4. Psychological and Social Support
• • Cognitive-behavioral therapy (CBT) to manage stress, anxiety, or depression
• • Support groups to improve coping and reduce isolation
• • Patient education on disease process, pacing activities, and treatment expectations
• 5. Complementary Therapies
• • Acupuncture, tai chi, yoga – may help reduce pain and improve flexibility
• Heat/cold therapy: Heat for stiffness; ice for inflammation

Question 12

Prevention & Long term management

Answer 12

• Know your triggers and prevent them
• Serum urate lowering therapy
• start ≥2 gout flares per year,
• Tophi (visible urate deposits), Joint damage from gout
• Chronic kidney disease (stage ≥2)
• History of uric acid nephrolithiasis (kidney stones)

Question 13

Gout triggers

Answer 13

• High Purine Diet (red meat, organ meats, seafood)
• Sugary drinks (energy drinks)
• Alcohol
• Diuretics (thiazide, loop diuretics
• Medications (ASA, niacin, tacrolimus
• Sudden stop of gout medication (allopurinol)
• Dehyrdation
• Crash diets
• Stress (trauma, surgery, infection)

Question 14

Carpal tunnel syndrome

Answer 14

• Presentation:
• Numbness, tingling, or burning in the thumb, index, middle, and radial half of the ring finger (median nerve distribution)
• • Symptoms worsen at night or with repetitive wrist use
• • Relief by shaking the hand (positive “flick sign”)
• • Pain may radiate up the arm
• Weakness or clumsiness in hand (especially with gripping or buttoning) (muscle atrophy)

Question 15

Referral to a specialist

Answer 15

• NO relief after 4-6 weeks of NSAIDS, PT, or conservative mgmt.
• Increased stiffness or progression of disease ( functional decline)
• Joint deformities on xray
• Positive autoimmune markers
• Symmetric joint pain, morning stiffness > 1hr  RA
• Frequent Flares (>2 per year despite tx)