Joint pain Flashcards
(155 cards)
1
Q
Three types of joints
A
fibrous
cartilaginous
synovial
2
Q
fibrous joints
A
sutures
syndesmosis
gomphoses
3
Q
two types of cartilaginous joints
A
synchondroses
symphyses
4
Q
describe synchondroses
A
advancing centres of ossification separated by hyaline cartilage
most are temporary and fuse in adulthood (e.g. epiphyseal growth plates)
some persist throughout life (e.g. costal cartilages) which allow some flexibility of rib cage
5
Q
describe symphyses
A
fibro-cartilage pads between a.c. of adjacent bones
allows slight movement
symphysis pubis allows expansion of pelvis in childbirth
some symphyses fuse during growth (e.g. sacral and coccygeal discs)
6
Q
6 types of synovial joints
A
- plane
- hinge
- pivot
- ellipsoid
- saddle
- ball and socket
7
Q
example of a plane joint
A
joint between metacarpal bones of hand
8
Q
example of a hinge joint
A
elbow
knee
interphalangeal joint
tibiotalar joint of ankle
9
Q
example of pivot joint
A
the joint of the first and second vertebrae of the neck that allows the head to move back and forth
The joint of the wrist that allows the palm of the hand to be turned up and down is also a pivot joint.
10
Q
example of the ellipsoid joint
A
the wrist
11
Q
example of the saddle joint
A
trapeziometacarpal joint at the base of your thumb. It connects the trapezium and the metacarpal bone of your thumb.
12
Q
example of ball and socket joint
A
your shoulder joint and your hip joint.
13
Q
what is a plane joint
A
called gliding joint or arthrodial joint, in anatomy, type of structure in the body formed between two bones in which the articular, or free, surfaces of the bones are flat or nearly flat, enabling the bones to slide over each other.
14
Q
what is a hinge joint
A
a type of synovial joint that exists in the body and serves to allow motion primarily in one plane. [1] The hinge joint is made up of two or more bones with articular surfaces that are covered by hyaline cartilage and lubricated by synovial fluid.
15
Q
what is a pivot joint
A
a freely moveable joint (diarthrosis) that allows only rotary movement around a single axis. The moving bone rotates within a ring that is formed from a second bone and adjoining ligament.
16
Q
what is a ellipsoid joint
A
a biaxial joint. An ellipsoid joint allows movements in all angular motions. The movement of ellipsoid joints is in two plains, back and front, and side to side.
17
Q
what is the saddle joint
A
The saddle joint gets its name because the bone forming one part of the joint is concave (turned inward) at one end and looks like a saddle. The other bone’s end is convex (turned outward), and looks like a rider in a saddle.
18
Q
what is a ball and socket joint
A
joint in which the rounded surface of a bone moves within a depression on another bone, allowing greater freedom of movement than any other kind of joint.
19
Q
2 layers of a joint capsule described
A
- outer fibrous capsule:
- blends with periosteum and tendons
- composed of dense irregular connective tissue
- highly innervated - inner synovial membrane (synovium)
- lines joint cavity except for articular surfaces
- produces constituents of synovial fluid
20
Q
2 main layers of synovium
A
- supporting layer or stroma (sub-intima)
2. lining of synovial cells in contact with synvoial fluid
21
Q
2 types of synovial cell
A
type A: derived from bone marrow
secretory and phagocytic functions
type B: type of fibroblast
role in synthesis of hyaluronic acid (HA) and proteins
22
Q
describe articular cartilage
A
- contains cells, fibres and matrix arranged in zones
- cells are chondrocytes ; density varies with age, morphology changes with different zones
- fibres are collagen
- matrix composed mostly of large aggregated proteoglycans
23
Q
describe subchondral bone
A
- cortical bone plate supported by trabecular bone
- in children perforated by blood vessels where it provides route for nutrient exchange
- shows biochemical and structural changes in some joint diseases
24
Q
describe ligaments
A
- regions of fibrous capsule thicken to form ligaments
- composed of dense regular CT comprising parallel collagen fibres
- this structural arrangement give ligaments great tensile strength along their length
25
describe menisci
discs or pads of fibrous-cartilage
| located within capsule, provide extra strength and support
26
describe bursae
often found where tendon passes over bone
| modified bursae form tendon sheaths around tendons
27
describe synovial fluid
fills joint cavity and bursae
| important role in lubrication and cartilage nutrition
28
describe the mechanical function of synovial joints
- synovial joints allow movement whilst providing stability
- shape of articulating surfaces influences type and range of movement
- increased mobility associated with reduced stability
29
what improves the stability of synovial joints
- capsule and ligaments surrounding joints
- internal ligaments e.g. cruciate in knee
- attachment of muscles and tendons across joint
30
high compressive and shear forces act on cartilage
| - what does this lead to
- loss of energy
- increase in temperature
- wear and tear at bearing surface
31
two main types of lubrication in synovial joints
fluid-film
| boundary
32
what does failure of joint lubrication lead to
increased friction and fibrillation of cartilage surface
roughened, fibrillated surfaces result in increased friction and wear and may lead to further cartilage damage
33
effects of mechanical loading on joints
-causes fluid changes in cartilage
| -
34
cartilage surface changes in osteoarthritis
fibrillation
erosion
cracks
35
what is fibrillation of cartilage
In such areas there is fraying and splitting of the cartilage, frequently accompanied by its local disintegration and erosion.
36
changes in cartilage in osteoarthritis
```
cartilage softening
chondrocyte necrosis
regeneration
cell cluster
cell proliferation
```
37
changes in the bone in osteoarthritis
```
joint space narrowing
marginal osteophytes
sclerosis
eburnation
focal pressure necrosis and subarticular cysts
```
38
what is sclerosis of the bone
an abnormal increase in density and hardening of bone
39
changes in synovium in osteoarthritis
mild to moderate inflammation
| neovascularisation
40
what is eburnation
the appearance of bone following a degenerative process in which subchondral or otherwise exposed bone acquires a non-anatomical sclerotic, microimpacted, and "polished" articular surface
Eburnation describes a degenerative process of bone commonly found in patients with osteoarthritis or non-union of fractures
41
clinical signs of osteoarthritis
```
swelling
muscle wastage
bony swelling
joint effusions
tenderness
warmth
reduced motion
crepitus
instability
```
42
symptoms of osteoarthritis
```
onset slow and insidious
use-related pain
joint stiffness after inactivity
reduced range of joint motion
functional limitation
```
43
what is a compression fracture
A type of break in a bone caused by pressure and in which the bone collapses. Compression fractures usually occur in the spine (backbone) and in bones made weak by cancer or by osteoporosis (a decrease in bone mass and density).
44
describe tensile forces on bones
A force that pulls apart both the axial ends is an example of tensile force. For tensile force to result in fracture, one end of a bone must be in a fixed position while the other end is forced away from the fixed end.
This will create a separation or avulsion fracture.
Common areas for this to occur include the tibial tuberosity, greater trochanter, and olecranon.
45
describe torsional forces on bones
his kind of force will be a force that tries to twist the bone along its long axis. This usually is a result of one end of a bone being placed in a fixed position while the other end of the bone is forced to rotate. Torsional forces generally result in short or long spiral fractures.
46
how long does a bone remodelling cycle take
3-4 months
47
describe a bone remodelling cycle (steps)
- initiation
- Resorption (-2 week process)
- osteoclast
- -osteoblast formation
- remodelling complete
- resting stage
- starts again
48
what is pycnodysostosis
a rare genetic disorder characterized by distinctive facial features and skeletal malformations. Affected individuals may have osteosclerosis, a condition characterized by abnormal hardening and increased density of bone.
49
what is osteoporosis
medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D.
50
what are bisphosphonate drugs (used for osteoporosis)
are a class of drugs that have been used commonly for more than two decades for the treatment and prevention of osteoporosis. Bisphosphonates slow bone resorption by reducing osteoclast function.
on an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. You'll also need to wait between 30 minutes and 2 hours before eating food or drinking any other fluids.
51
physiology of bone remodelling
consists of three consecutive phases: resorption, during which osteoclasts digest old bone; reversal, when mononuclear cells appear on the bone surface; and formation, when osteoblasts lay down new bone until the resorbed bone is completely replaced.
52
difference between anabolic and bisphosphonates used to treat osteoporosis
bisphosphonates - decrease osteoclast resorption (alendronic acid.)
anabolic drugs - promote new bone formation (teriparatide)
53
(Joint Pain Case)
66 year old man who is struggling with pain and stiffness in his left knee
recently retired and plays golf regularly but his pain is limiting his ability to enjoy a full round with his friends
no abnormality upon examination
Does he need imaging?
What do you think it is?
doesn't need imaging
| most likely osteoarthritis
54
(Joint Pain Case)
19 year old man with knee pain and swelling following a football game
he was tackled by another player with a twisting injury and direct impact to his left knee
on examination there is a large effusion and a positive Lachmans test
what does a Lachmans test test for?
What imaging would he need?
Lachman's test tests for an ACL injury
| Xray is first line for imaging but might require an MRI to look at the soft tissue and ligaments
55
How to perform a Lachman's test
its an alternative test assessing for laxity or rupture of the anterior cruciate ligament (ACL)
1. Flex the patient’s knee to 30°.
2. Hold the lower leg with your dominant hand with your thumb on the tibial tuberosity and your fingers over the calf.
3. With the non-dominant hand, hold the thigh just above the patella.
4. Use the dominant hand to pull the tibia forwards on the femur while the other hand stabilises the femur.
Significant anterior movement of the tibia on the femur suggests ACL laxity or rupture.
56
what does ACL laxity mean
loose knee ligaments
57
limitations of plain radiographs
poor soft tissue definition
early changes are often occult ( not accompanied by readily discernible signs or symptoms.)
2D representation of 3D structure
58
limitations of MRI
slow, expensive and claustrophobic
can overestimate severity of benign lesions
not everyone can have an MRI
59
Osteoarthritis classically results in LOSS (what does the acronym stand for) think on radiographs
Loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts
60
what is subchondral sclerosis
under the cartilage bone growth (DENSE)
61
what are subchondral cysts
as subchondral bone takes more stress it grinds against the bone which eventually forms cysts
indicative of more severe osteoarthritis
62
define osteophyte
a bony projection associated with the degeneration of cartilage at joints.
63
brief description of rheumatoid arthritis
chronic autoimmune inflammatory disease
affects the synovium/ joints but onset can be insidious and may present with systemic symptoms of tiredness, malaise, and ache
64
radiological manifestations of rheumatoid arthritis
- soft tissue swelling due to joint effusion and synovitis
| - symmetrical joint involvement (joint space loss, and marginal erosions)
65
what is osteopenia
one loss before osteoporosis (osteopenia)
The stage before osteoporosis is called osteopenia. This is when a bone density scan shows you have lower bone density than the average for your age, but not low enough to be classed as osteoporosis. Osteopenia does not always lead to osteoporosis
66
what is chondrocalcinois
non specific term for calcium deposition within articular hyaline and fibrocartilage
67
what is an aneurysmal bone cyst
a benign, blood-filled lesion in the bone that tends to expand or grow. While it is referred to as a cyst, it is a true benign bone tumor surrounded by a thin wall of bone. Aneurysmal bone cysts (ABCs) can occur in any bone, but are most commonly found around the knee, pelvis or spine.
68
what is osteosarcoma
he most common type of cancer that starts in the bones. The cancer cells in these tumors look like early forms of bone cells that normally help make new bone tissue, but the bone tissue in an osteosarcoma is not as strong as that in normal bones.
69
what does a lower motor neurone lesion correspond to
to a lesion in the peripheral nervous system
70
Lower motor neurone neurological examination overview
```
inspection
screening tests - gaits
tone "floppiness"
power
reflexes
sensation
co-ordination
```
71
difference between radiculopathy and neuropathy
Peripheral neuropathy is the damage of the peripheral nervous system, such as carpal tunnel syndrome that involves trapped nerves in the wrist. Radiculopathy is the pinching of the nerves at the root, which sometimes can also produce pain, weakness and numbness in the wrist and hand.
72
Rombergs Test
stand with feet together and eyes closed
tests proprioception
positive test = loss of balance
73
what could an abnormal heel-shin test be due to
lower limb weakness
impaired joint proprioception
cerebellar disorder
74
describe inspection in a lower limb neurological exam
- how they walk into a room/get on a couch
- general: IV track marks, body habits, scars, etc.
- muscle activity: wasting, fasciculation, jerking
- limb posture: pyramidal, contractures
75
what are pyramidal findings on a neurological exam
motor abnormalities on neurological exam (e.g., hyperreflexia, focal weakness, extensor response). Extrapyramidal findings in sJCD typically include rigidity, slowed movement (bradykinesia), tremor, or dystonia, typically due to problems in the basal ganglia or its connections.
with pyramidal meaning
relating to or denoting a tract of motor nerves within the pyramid of the medulla oblongata.
76
what is an antalgic gait
An antalgic gait is an abnormal gait pattern which develops as a result of pain. Typically the stance phase is reduced on the affected leg resulting in a limping appearance.
77
difference between rigidity and spacisity
Spasticity refers to a condition, which leads to an abnormal increase in muscle tone, interfering with movement and speech, while rigidity refers to a condition of muscles characterized by the inability to relax normally. Thus, this is the main difference between spasticity and rigidity.
Whereas spasticity arises as a result of damage to the corticoreticulospinal (pyramidal) tracts, rigidity is caused by dysfunction of extrapyramidal pathways, most commonly the basal ganglia, but also as a result of lesions of the mesencephalon and spinal cord.
78
MRC scale for muscle
grade 0 - no muscle movement
grade 1 - flicker or trace of muscle movement
grade 2 - active movement with gravity eliminated
grade 3 - active movement against gravity
grade 4 - active movement against gravity and resistance
grade 5 - normal power
79
who should we assess for osteoporosis
```
women over 65
men over 75
women 50-64 and men 50-74 if:
-previous fracture
-glucocorticoids
-history of falls
-family history of hip fracture
-other causes of secondary osteoporosis
-low BMI
-excessive alcohol or smoking history
```
80
what is a FRAX score
- provides an estimate of future fracture risk
- incorporates risk factors
- uses 9 prospective population based cohorts
- can be used with or without DXA
81
what is DXA
dual x-ray absorptimetry
- provides an assessment of bone mineral density
- usually assesses he lumbar spine and hips
- lowest value taken
- results provided as a T score
- can also carry out a vertebral fracture assessment (VFA)
82
WHO T score for osteopenia
between -1 and -2.5
83
WHO T score for osteoporosis
less than -2.5
84
investigations in patients at high risk of fractures
blood tests
- vit d
- thyroid function
- coeliac disease
- testosterone deficiency
- PTH
- Serum calcium
Other cause
- myeloma screen
- evidence of metastatic malignancy
85
impact of vertebral fractures
pain
disability
loss of independence
lack of self esteem
86
treating osteoporosis
lifestyle advice:
modification of risk factors
exercise:
weight bearing activity
medications:
including optimising calcium and vitamin D
87
how to take bisphosphonates
on an empty stomach
| upright with a glass of water 30 mins before food/drink/supplements
88
what is vitamin d deficiency called in children and adults
children - Rickets
| adults - osteomalacia
89
severe vitamin d deficiency clinical features
| raised what and low what?on blood test
```
bone pain and muscle weakness / bone tenderness / waddling gait
raised PTH
raised ALP
25 - hydroxyvitamin D very low
calcium and phosphate may be low
```
90
what is Pagets disease
disease of bone interferes with your body's normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time, bones can become fragile and misshapen. The pelvis, skull, spine and legs are most commonly affecte
91
role of PTH in bone remodelling
PTH enhances the number and the activation of osteoblast through 4 pathways: increasing osteoblast proliferation and differentiation, decreasing osteoblast apoptosis and reducing the negative effects of peroxisome proliferator activator (PPAR)γ receptor on osteoblast differentiation.
92
what do cervical vertebrates have (spine)
cervical spine has vertebral foramen for the vertebral arteries
93
describe compression fractures
- vertical pressure
- loss of vertebral height
- causes - trauma or previous weakening (weakening caused by osteoporosis, osteogenesis imperfecta, metastatic lytic lesions, or infection)
- best seen on the lateral view X-ray
- stable vs. unstable depending on amount of columns affected
94
treatment for compression fractures
- can be treated conservatively if stable
- treat underlying condition (osteoporosis)
- vertebroplasty can be considered if ongoing pain
- needs urgent surgical review if unstable
95
wedge fractures (spine)
typically osteoporotic fractures
single column
stable fractures
(this fracture usually occurs in the front of the vertebra, collapsing the bone in the front of the spine and leaving the back of the same bone unchanged, which results in the vertebra taking on a wedge shape.)
96
burst fracture (Spine)
usually traumatic
more than 1 column involved
unstable
usually seen on a CT rather than a radiograph due to trauma protocols
97
types of clinical pain
```
inflammatory pain
cutaneous pain
post-operative pain
cancer pain
neuropathic pain
visceral pain
migraine/headache
```
98
descriptors of pain
duration: acute/chronic (> 3 months)
pathology: inflammatory , traumatic, neuropathic
trigger: stimulus evoked, spontaneous, delayed
origin: somatic - skin/muscle/bone, visceral - heart/kidneys/GI
characteristics: shooting, lacinating, electric, burning, freezing, cramping, aching
99
what is nociception
detection of a stimulus which is potentially (or actually) damaging
can have nociception without pain or pain without nociception
100
treatment options for acute pain
Acetaminophen is the first-line treatment for most mild to moderate acute pain. Ibuprofen and naproxen (Naprosyn) are good, first-line NSAIDs for mild to moderate acute pain based on effectiveness, adverse effect profile, cost, and over-the-counter availability.
101
normal curvature of spine for C1-C7
lordotic - in towards the body - allows movement
102
normal curvature for thoracic spine
kyphotic - little movement because fixed to the ribs
103
normal curvature for lumbar spine
lordotic - allows movement (like bending forward and backward)
104
(joint pain case) symptoms that suggest life threatening pathology
```
weight loss
lethargy
night sweats
fevers
rest pain
progressive severe pain
```
105
(joint pain case) symptoms that suggest limb threatening pathology
```
sphincter disturbance (incontinence, retention, sexual disturbance)
bilateral leg pain
```
106
clinical signs that raise concern in joint pain
saddle anaesthesia
objective neurological deficit - sensory/motor/both
(reduced anal tone)
cachexia
107
specific diagnoses for back pain
```
herniated disc
cauda equina syndrome
degenerative spinal stenosis
spinal tumours
spinal infection
spinal trauma
inflammatory arthropathy
extraspinal disease
```
108
describe herniated intervertebral disc
very common
presents with leg pain
most patients improve with conservative measures alone
surgery for those that pain is prolonged for or difficult to control
109
cauda equina syndrome basics
surgical emergency
back pain: acute onset, painless urinary incontinence/retention, bilateral (or unilateral) leg radiculopathy, motor deficit, saddle anaesthesia, sexual dysfunction
symptoms are not specific or sensitive, if missed patients are often left with lifelong disability
get an MRI ASAP
discuss early with spinal surgeons
110
what is degenerative spinal stenosis
is a common cause of disabling back and lower extremity pain among older persons. The process usually begins with degeneration of the intervertebral disks and facet joints, resulting in narrowing of the spinal canal and neural foramina.
111
two causes of spinal infection
discitis
| vertebral osteomyelitis
112
what is discitis
nfection of the discs between the vertebra of the spine. Like appendicitis, discitis is usually a bacterial infection but may be viral.
113
what is vertebral osteomyelitis
is a rare spinal infection. Osteomyelitis, the name for a painful bone infection that develops from bacteria or fungi, is itself rare. Vertebral osteomyelitis can happen as the result of an injury to your spine or after surgery.
114
what is a dermatome
an area of skin in which sensory nerves derive from a single spinal nerve root
115
what is a myotome
myotome refers to the muscles served by a spinal nerve root.
116
describe inflammatory joint pain
```
heavy leaden, burning, throbbing
presents/worsens with rest
improves with movement, stretching, cracking
significant stiffness
red, hot and swollen
flares or attacks
```
117
describe mechanical joint pain
```
sometimes absent
sharp or grinding
most tolerable at rest
worsens with movement
reproduced with specific movement
occasionally swollen
```
118
examples of inflammatory joint pain
rheumatoid arthritis
Psoriatic joint pain
gout
septic arthritis
119
examples of mechanical joint pain
osteoarthritis
cartilage tear
tendon/ligaments
120
where can hip synovitis pain be referred to
to the groin/outer thigh pain radiating to the knee
121
carpel tunnel syndrome referred pain
pain or paraesthesia can be reported in all fingers but detailed assessment then is needed to disclose the 5th finger sparing
122
describe bone pain
generally constant despite movement or change in posture unlike muscular, synovial, ligament or tendon pain
often disturbs sleep
123
what is GALS and what does it stand for
a screen tool for joint examination
| gait. arms, legs, spine
124
describe the G in GALS
gait
observe gait
observe patient in anatomical position
125
Describe the A in GALS
```
Arms
observe movement -hands behind head
observe back of hands and wrists
observe palms
assess power grip and grip strength
assess fine precision pinch
squeeze MCPJs
```
126
describe L in GALS
```
legs
assess full flexion and extension
assess internal rotation of the hips
perform patellar tap
inspect feet
Squeeze MTPJs
```
127
describe S in GALS
spine
inspect spine
assess lateral flexion of the neck
assess lumbar spine movement
128
causes of gout
```
male gender
increasing age in women
ethnicity
being overweight
alcohol use (beer being the highest risk)
renal insufficiency
hypertension
```
129
causes of psuedogout
```
acute illness chest or urinary infection
joint trauma
chondrocalcinosis
hyperparathyroidism
chronic vitamin d deficiency
hypomagnesaemia
hypophosphatasia
haemochromatosis
```
130
difference between gout and psuedogout
think about what crystals they form
Pseudogout and gout are both types of arthritis, and they're both caused by the accumulation of crystals in the joints. While pseudogout is caused by calcium pyrophosphate crystals, gout is caused by urate (uric acid) crystals.
131
clinical presentation of gout
characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe. An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire.
132
clinical presentation of pseudogout
Physical examination findings show an acutely inflamed joint with swelling, effusion, warmth, tenderness, and pain on range of motion similar to acute gouty arthritis. This typically occurs in the knee but may be present in the wrists, shoulders, ankles, hands, and feet.
133
clinical presentation of housemaids knee
aka prepateller bursitis
Tenderness and swelling superficial to the patella. Erythema and localised warmth of the skin over the patella. Reduced knee movement. Fever, tachycardia or signs of systemic upset may indicate septic bursitis
134
clinical presentation of a ruptured bakers cyst
A Baker's cyst can sometimes rupture (burst), resulting in fluid leaking down into your calf. This causes a sharp pain in your calf, which becomes swollen, tight and red, but redness can be harder to see on brown and black skin. The fluid will gradually be reabsorbed into the body within a few weeks.
135
what is a bakers cyst
A Baker's cyst can form when joint-lubricating fluid fills a cushioning pouch (bursa) at the back of your knee. A Baker's cyst is a fluid-filled cyst that causes a bulge and a feeling of tightness behind your knee.
136
what is a housemaids knee
Housemaids knee is a swelling in the sac at the front of the knee called the prepatellar bursa. This sac sits on top of the knee cap. The prepatellar bursa is one of four bursae in the knee. Less frequently, other bursae are affected.
137
```
rheumatoid arthritis
gender it affects
age it affects
genetics
environment
```
gender - before menopause it is 3 times more likely in women than men
age - mean age of onset is 30-50 but can affect any age
genetics - strong associations with HLA-DR4 and HLA-DR1
environment - smoking, infection, diet or hormonal
138
some hand clinical features of rheumatoid arthritis
```
ulnar deviation
Boutonniere deformity
z shaped thumb
swan neck deformity
MCP subluxation
```
139
what is subluxation
A dislocation occurs when the bones in a joint become separated or knocked out of their usual positions. Any joint in the body can become dislocated. If the joint is partially dislocated, it is called a subluxation.
140
what is a Boutonniere deformity
Boutonnière deformity is the result of an injury to the tendons that straightens the middle joint of your finger. The result is that the middle joint of the injured finger will not straighten, while the fingertip bends back.
141
what are spondyloarthropathies
- collective name given to seronegative inflammatory arthridites that are different to rheumatoid in their clinical features, because of different underlying pathophysiology
- are not a small joint polyarthropathy of the hands and feet
- may be symmetrical or asymmetrical
- may involve the spine
- often involves tendons rather than joints
142
```
psoriatic arthritis
gender
age
genetics
environmental
```
```
is a spondyloarthropathy
gender - affects men and women equally
age - 30-50 but can affect any age
genetics - association with caucasians and HLA - B27
environment - HIV
```
143
```
enteropathic associated arthritis
prevalence
gender
age
genetics
environmental risk factors
```
is a spondyloarthropathy
associated with bowel
prevalence: 1 in 5 people with IBD
gender: equal
age: 15-40 but older people can also be affected
genetics: more common in people of jewish descent
environment: bovine mycobacterium (drinking unpasteurised milk) , smoking
144
```
ankylosing spondlyitis
prevalence
gender
age
genetics
environmental risk factors
```
is a spondyloarthropathy
prevalence: 1 in 1000
gender: 3x more common in men than women
age: peak age of onset is 17-35
genetics: 90% carry the HLA-B27 gene
environment: unknown
145
```
systemic lupus erythematous
prevalence
gender
age
genetics
environmental risk factors
```
an inflammatory arthritis
prevalence: 1 in 10,000
gender: 10x common in women than men
age: mean onset is 20-40
genetics: more common in afro-carribeans and asians, associated with HLA - DR2 and HLA - DR3
environmental risk factors: sun, smoking and medications such as isoniazid, phenytoin, carbamazepine, and sulphasalazine
146
what is systemic lupus erythematous
Lupus is a condition that affects the immune system. It can cause problems with your skin, joints, kidneys and other organs.Symptoms of lupus include joint and muscle pain, extreme tiredness and a rash on your face.
There's currently no cure for lupus, but the symptoms can often be treated with medicines that reduce inflammation in your body, such as steroids.
Lupus is caused by your immune system mistakenly attacking healthy parts of your body. It's not fully understood why this happens.
147
```
define pannus
(what disease is it associated with)
```
a type of extra growth in your joints that can cause pain, swelling, and damage to your bones, cartilage, and other tissue. It most often results from rheumatoid arthritis, an inflammatory disease that affects your joints, though other inflammatory diseases are also sometimes to blame.
148
what is an ANA test
an antinuclear test
generic test
can test for lupus
An ANA test detects antinuclear antibodies (ANA) in your blood. Your immune system normally makes antibodies to help you fight infection. In contrast, antinuclear antibodies often attack your body's own tissues — specifically targeting each cell's nucleus.
149
reactive arthritis
a bowel, urogenital, or upper respiratory tract infection that triggers a sudden onset inflammatory arthritis
occurs around 7-10 days post infection
seronegative, often not symmetrical, often involving larger joints, often HLA - B27 positive
settles after 6-9 months
150
blood tests to aid in diagnosis of inflammatory joint pain
inflammatory markers: ESR, CRP, PV
FBC
uric acid levels
151
why is PV blood test raised in inflammatory joint pain
PV - plasma viscosity
it is a general measure of how much protein is in the serum
raised in inflammatory joint pain because of the antibodies produced
152
common causes of hyperuricaemia
diuretic medications
increasing age
diet
153
what is hyperuricaemia associated with
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hypertension
obesity
alcohol intake
diabetes
genetics
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Hyperuricaemia or hyperuricemia is an abnormally high level of uric acid in the blood
(associated with gout)
154
which colour of synovial fluid is indicative of an inflamed joint
yellow and not clear
155
causes of hemarthrosis
-trauma or injury, like a sprain, fracture, or torn ligament.
surgery, including arthroscopic surgery.
-a bleeding disorder, such as hemophilia.
-medications used to prevent blood clots (blood thinners) such as warfarin.
-certain infections.
