MSK Flashcards
(25 cards)
What are the differential diagnosis of back pain?
Mechanical pain Muscular pain Lumber disc prolapse Lumber spine stenosis Cauda equina syndrome Dorsal root irrigation Acute cord compression
What are the medications that can be given in acute simple back pain or nerve root pain?
NSAID - first line
Paracetamol
Diazepam - muscle relaxant
TCA - amitriptyline
What other conservative management options are there for back pain other then medication?
Physio
Heat therapy
Massage
Acupuncture
What is the differential diagnosis for RA?
Gout
Septic arthritis
OA
Psoriatic arthritis
What should be done in primary care for someone suspected with RA?
Refer to specialist for assessment to confirm diagnosis (within 3 weeks of referral)
Should be within 3 working days if:
- small joints of hand or feet affected
- more then one joint affected
- delay of 3 months or longer since onset of symptoms and person seeking medical advise
Short course of NSAIDs at lowest possible dose alongside PPI should be given to manage symptoms until rheumatologist review.
How should a flare of RA be managed in primary care?
Exclude septic arthritis
Seek specialist advise
Offer short term treatment with glucocorticoids (intra-articular, IM methylprednisolone acetate (40mg in 1ml) or oral prednisolone 10mg for 7 days the 5mg for 7days)
What is polymyalgia rheumatica?
Condition with similar presentation to RA but for proximal joint rather then distal - usually the shoulder girdle
What is palindromic rheumatism?
Rare form of inflammatory arthritis. Attacks of joint pain and swelling similar to RA but joints return to normal between attacks. May later develop into RA.
What are the extra-articular manifestations of RA?
- pulmonary fibrosis with pulmonary nodules (Caplans syndrome)
- bronhiolitis obliterens (inflammation cause small airway destruction)
- felty syndrome (RA, neutropenia and splenomegaly)
- secondary Sjögren’s syndrome
- anaemia of chronic disease
- CVD
- Episcleritis and scleritis
- rheumatoid nodules
- lymphadenopathy
- carpal tunnel syndrome
- amyloidosis
What are the x-ray changes seen on RA?
Loss of joint space
Erosion -bony
Soft tissue swelling
Softening of the bone(osteopenia)
When can a diagnosis of OA be made clinically?
Aged 45 or over
Activity related joint pain
No morning stiffness or lasting longer then 30 mins
What may be seen on examination on some with OA?
Bony swelling and deformity due to osteophytes
Herberdens nodes
Bouchards nodes
What teams may referral be required or in pt with OA?
Physio OT Podiatry Orthopaedic Pain clinic Psychological services
What is the management of OA in primary care?
Lifestyle advise - weight loss, diet, smoking cessation, increase exercise
Medications:
- paracetamol + topical NSAIDs or topical Capsaicin
- oral NSAIDS and opioids
- intra-articular steroid injections
What is the most affected joint in gout?
Big toe - 1st metatarsal
Podegra
What investigations should be done in suspected gout?
Aspiration of fluid to check uric acid level
Measure serum urate
What is an important differential to rule out is suspected gout?
Septic arthritis
What is gout an independent risk factor for?
CKD
MI
CVD
What is the management of acute attack of gout?
Attack usually resolve within 1-2 weeks
NSAIDS which should be continued 1-2 day after attack settled or colchicine
Systemic steroids if NSAIDS and colchicine not appropriate
Paracetamol as an adjunct for pain relief
Self care advise - RICE
Lifestyle advice - weight loss and smoking cessation
What should be done if there is inadequate response to treatment after 1-2 days of gout?
Diagnosis should be reviewed
Compliance checked
Increase dose
What urate-lowering therapy (ULT) can be offered to someone with gout?
2 or more attacks within a year:
Allopurinol - first line
Febuxostat - 2nd line
Co-prescription of NSAIDs or colchicine
What is pseudogout?
Usually affects the knee and is calcium pyrophosphate dehydrate crystals rather then mono sodium urate
What are the patterns of psoriatic arthritis?
Symmetrical poly arthritis - similar to RA
Asymmetrical pauciarthirits - few joints - such as digits of finger and toes
Spondylitic pattern - more common in men, back stiffness, sacroilitis, Atlanta-axial joint involvement
Spine, Achilles’ tendon or planter fascia may be affected
What are the signs of psoriatic arthritis?
Plaques of psoriasis of skin Pitting of nails Onycholysis Dactylitis Enthesitis - inflammation of the points of insertion of tendons on bone
