Joints Flashcards
What is osteoporosis?
- disease of old age
- primarily affects women but affects men as well
- results in fractures of mainly the wrist, spine and hip
What are the consequences of a hip fracture?
- prolonged hospital admission
- death from complications
- hospital acquired infections
- VTE
- significant mobility problems
What is the pathophysiology of osteoporosis?
- trabecular bone becomes weaker, more porous, low bone density and mass
- reduced osteoblast activity
- increased osteoclast activity
bone is being broken down quicker than it can be formed
How does a low peak bone mass increase the risk of developing osteoporosis?
- peak bone mass age 25 - 40
- lose bone density at a rate of 1% / year
What is defined as being susceptible to fractures?
fractures occurring from falling from standing height or less
What is the bone remodelling cycle?
- 100 days (3 months)
- resting phase
- activation phase (a small hole will trigger the activity of osteoclasts), triggers resorption
- reversal phase, triggers osteoblasts
What are the signs and symptoms of osteoporosis?
- fracture
- reduced bone density on DXA scan
- pain
- reused mobility
- kyphosis (curving of the spine, causing indigestion)
- reduction in height
What are the consequences of spine fractures?
- often goes unnoticed, put down to old age with back pain
- reduced mobility
- height reduction (10 - 20cm)
- indigestion
- neck weakness
- back pain
DXA Scans
- scans the hip/spine to calculate a T score
- T score of -2.5 or below = osteoporosis
- only for high risk patients OR those with established osteoporosis
What are the risk factors for developing osteoporosis?
- history of fractures
- history of fractures in first degree relative
- smoking
- low body weight (underweight)
- female
- oestrogen deficiency (lower than menopause levels)
- corticosteroid use (prednisolone)
- white race
- increase in age
- low calcium intake
- exces alcohol
- recurrent falls
- dementia
- impaired eyesight
- poor health/frailty
What is the primary prevention for osteoporosis?
- adequate calcium and vitamin D
- weight bearing exercise
- reduced alcohol intake
- stop smoking
- reduce risk of falls (e.g. medications in elderly)
What is the secondary prevention for osteoporosis?
- Calcium
- Vitamin D
- Calcitriol
- Calcitonin
THEN - Bisphosphonates
- HRT/SERMS
- Strontium
- Parathyroid Hormone
- Denosumab
What is osteoarthritis?
- disease of wear and tear
- affects 1 or 2 joints
- onset most common 40 - 60
- more common in women
- obesity increases the risk
What are the signs and symptoms of osteoarthritis?
- joint pain, worsened on movement
- gradually gets worse over the course of the day
- early morning stiffness 30 mins, but joints remain painful
- swelling IF inflammation present
- knee, hands, lumbar, cervical spine
- some joints repair themselves, some don’t
What is the pathogenesis of osteoarthritis?
- cartilage gradually roughens and becomes thin
- causes thickening of the underlying bone
- bones move closer together and may touch
- formation of osteophytes
- MAY get thickening and inflammation of synovium
- thickening and contraction of ligament (bone - bone attachment) which makes if painful to move
What are the non-pharmacological treatments for osteoarthritis?
- weight reduction
- physiotherapy
- exercise plan
- heat packs/cold packs
- occupational health - optimise mobility
- surgery
What are the pharmacological treatments for osteoarthritis?
- simple analgesics
- NSAIDS IF INFLAMMATION IS PRESENT
- corticosteroid injections into the joint
- chondroprotective agents glucosamine
What is rheumatoid arthritis?
an autoimmune SYSTEMIC condition that affects any age, and many joints
- common onset 30 - 50 years
- reduced life expectancy as more likely to have other conditions
- more women affected than men
What are the signs and symptoms of rheumatoid arthritis?
- slow progressive symmetrical poly arthritis (small joints affected)
- pain and stiffness in the joints of the hands and feet
- wrists, shoulders, elbows, knees, ankles
- early morning stiffness, stiffness worsens throughout the day whilst pain improves
- most people have remitting and relapsing disease (flares)
What are the extra-articular symptoms of rheumatoid arthritis?
- Sjorgens syndrome
- Vasculitis
- Neuropathy
- Subcutaneous nodules (build up of tissue over the joint)
- Lymphadenopathy
- CVD
- Depression
- Respiratory Disease
What is the pathogenesis of Rheumatoid Arthritis?
- lymphocytes infiltrate synovial membrane
- inflammation and thickening
- formation of panes over cartilage causes erosion into bone
- degeneration of cartilage and joint
What is are the pharmacological treatment options for Rheumatoid Arthritis?
- Analgesics
- NSAIDs
- Conventional DMARDs
- Biological DMARDs
What is the gold standard treatment for rheumatoid arthritis?
methotrexate + hydroxycholorquine
bisphosphonates counselling points
poorly absorbed by the body:
- take on an empty stomach
- take with a whole glass of water
- don’t eat for 30 minutes after
- sit upright for 30 mins - hour afterwards to prevent heartburn
- long term treatment
- falls with no fractures
indicates it’s working
- if not tolerated can switch to a different bisphosphonate
- take calcium containing medicines 3 - 4 hours before
