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MSK Flashcards

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1
Q

What is rheumatoid arthritis?

A

An autoimmune condition in which autoantibodies attack and destroy the synovial lining of synovial joints

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2
Q

What are the symptoms of rheumatoid arthritis?

A
  • Morning stiffness/pain lasting MORE than 30 mins

- Stiffness/pain EASES with use

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3
Q

Describe the physical examination results/signs of rheumatoid arthritis.

A
  • Ulnar deviation
  • Swan-neck deformity
  • Boutonierre deformity
  • Z thumb
  • Active synovitis (red, hot, swollen joints)
  • Pattern of joint involvement = symmetrical, mostly affecting wrists, hands and feet
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4
Q

What are the extra-articular manifestations of rheumatoid arthritis?

A
  • Anaemia
  • Neuropathy
  • Vasculitis
  • Lungs: Caplan’s syndrome (RA + pneumoconiosis = intrapulmonary nodules)
  • Eyes: Sjogren’s syndrome (causing severe dry eyes), scleritis
  • Felty’s syndrome: RA + splenomegaly + neutropenia
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5
Q

How is rheumatoid arthritis investigated?

A

Bloods:

  • FBC may show anaemia
  • ESR/CRP = raised
  • Autoantibody screen (rheumatoid factor and anti-CCP)

X-ray shows characteristic changes -‘LESS’:

  • Loss of joint spacing
  • Erosion
  • Soft tissue swelling
  • Soft bones (osteopenia)
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6
Q

Describe the pharmacological management of rheumatoid arthritis

A
  • 2 DMARDs, one being Methotrexate, other = Azathioprine or Sulfasalazine
  • Analgesia
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7
Q

What is osteoarthritis?

A

Degenerative condition of articular cartilage

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8
Q

Describe the pathophysiology of osteoarthritis

A
  • Loss of articular cartilage =exposure of underlying bone

- This leads to subchondral sclerosis/cysts and osteophyte formation

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9
Q

What are the risk factors for osteoarthritis?

A
  • Age (50+)
  • Obesity
  • Previous injury/trauma
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10
Q

What are the symptoms of osteoarthritis?

A
  • Morning stiffness/pain lasting LESS than 30 mins

- Pain after exercise/at the end of the day (after use)

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11
Q

Describe the physical examination results/signs of osteoarthritis

A
  • Heberden’s nodes (DIPJs)
  • Bouchard’s nodes (PIPJs)
  • Base of thumb (1st MCPJ) and base of big toe (1st MTPJ)
  • Hard, bony swelling
  • Crepitus
  • Pattern of joint involvement: asymmetrical, affecting joints which are used most (hands, feet, knees, hips)
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12
Q

How is osteoarthritis investigated?

A

Usually clinical diagnosis

X ray shows characteristic changes - ‘LOSS’:

L - Loss of joint spacing
O - Osteophytes
S - Subchondral sclerosis
S - Subchondral cysts

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13
Q

Describe the conservative management of osteoarthritis

A

Lifestyle advice: weight loss, low impact/non-weight bearing exercise

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14
Q

Describe the pharmacological management of osteoarthritis

A
  • Analgesia

- Steroid injections

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15
Q

Describe the interventional management of osteoarthritis

A

Surgery: joint replacement

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16
Q

The ‘crystal arthropathies’ include which conditions?

A

Gout (much more common)

Pseudogout

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17
Q

What are the symptoms of gout/pseudogout?

A

5 cardinal signs of inflammation in joint:

  • Calor (hot)
  • Rubor (red)
  • Dolor (painful)
  • Tumor (swollen)
  • Loss of function
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18
Q

How are gout/pseudogout investigated?

A

Joint fluid aspirate analysis
(MUST exclude septic arthritis by MC+S)

Crystals analysed by CPM (compensated polarised microscopy)

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19
Q

Which joint is most commonly affected in gout? Describe the joint distribution.

A
  • 1st MTPJ

- Usually one joint affected (monoarthropathy)

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20
Q

Describe the chemical composition and structure of the crystals present in gout

A
  • Monosodium urate

- Positive birefringence, needle-shaped crystals

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21
Q

What are the risk factors for developing gout?

A
  • Male
  • Diet high in purines (meat/seafood)
  • Excess alcohol
  • Drugs: diuretics
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22
Q

Describe the conservative management of gout

A

Lifestyle advice:

  • Weight loss
  • Reduce amount of purines in diet (meat, seafood etc.)
  • Avoid alcohol (in excess)
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23
Q

Describe the pharmacological management of gout (both for acute attacks and prevention)

A

Treatment in acute attacks:

  • NSAIDs
  • Colchicine

Prevention:

  • Stop diuretics
  • Allopurinol
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24
Q

Which joint is most commonly in pseudogout? Describe the joint distribution

Study These Flashcards
A
  • Knee

- Usually more than one joint affected (polyarthropathy)

25
Describe the chemical composition and structure of the crystals present in pseudogout
- Calcium pyrophosphate | - Positive birefringence, rhomboid-shaped crystals
26
What are the risk factors for developing pseudogout?
- Elderly - Dehydration - Intercurrent illness/surgery/trauma
27
Describe the pharmacological management of pseudogout
NSAIDs
28
What is osteoporosis?
Progressive loss of bone mass and therefore bone strength, making bones fragile and more susceptible to fracture
29
Describe the pathophysiology of osteoporosis
Trabecular loss | Cortical thinning
30
What are the risk factors for osteoporosis?
'ACCESS' ``` A - alcohol C - corticosteroids C - calcium low E - estrogen low S - smoking S - sedentary lifestyle ```
31
Which sites are most commonly affected by osteoporosis?
- Vertebrae - Neck of femur - Proximal humerus - Distal radius
32
How is osteoporosis investigated?
``` DEXA scan for bone mineral density: T score (difference between normal healthy adult and the result of DEXA scan) < -2.5 = osteoporosis ```
33
Describe the conservative management of osteoporosis
Lifestyle advice - reduce risk factors: - Reduce alcohol intake - Adequate calcium and vitamin D intake (supplementation) - Stop smoking - Exercise
34
Describe the pharmacological management of osteoporosis
- Bisphosphonates, e.g. alendronic acid: inhibit action of osteoclasts, so inhibit bone resorption - Calcium and vitamin D supplementation, e.g. Adcal D3
35
What are the side effects of the drugs used to treat osteoporosis?
Side effects of bisphosphonates: - GI disturbance - Oesophageal erosion
36
The 'seronegative (or spondylo-) arthrpathies' include which conditions?
- Ankylosing spondylitis - Psoriatic arthritis - Enteropathic arthritis - Reactive arthritis
37
Ankylosing spondylitis most commonly affects...
Young males
38
What are the symptoms of ankylosing spondylitis?
- Lower back pain - Alternating buttock pain - Systemic features: fever, fatigue
39
Give some extra articular features of ankylosing spondylitis
A's... - Achilles tendinitis - Apical pulmonary fibrosis - Acute anterior uveitis
40
How is ankylosing spondylitis investigated?
Bloods: - CRP/ESR raised - Autoantibody screen (RF, anti-CCP) is negative X-ray = Bamboo spine - 'BOSS': B - blurring O - ossification of spinal ligaments S - sclerosis S - syndesmophyte fusion
41
Enteropathic arthritis is associated with...
IBD
42
Describe the skin changes (signs) which may be present in enteropathic arthritis
- Erythema nodusum | - Pyoderma gangrenosum
43
What is reactive arthritis?
Inflammatory arthritis occurring 1-6 weeks after a GU/GI infection
44
Which bacteria most commonly cause reactive arthritis?
GI: Campylobacter, Salmonella, Shigella GU: Chlamydia
45
Which syndrome is associated withe reactive arthritis?
Reiter's syndrome: arthritis, urethritis, conjunctivitis
46
What is septic arthritis?
Inflammation of a joint caused by bacterial infection
47
What are the symptoms/signs of septic arthritis?
5 cardinal signs of inflammation: - Rubor (red) - Calor (hot) - Dolor (pain) - Tumor (swollen) - Loss of function Systemic features: fever Mostly monoarthopathy
48
How is septic arthritis investigated?
Joint fluid aspirate analysis (MC+S)
49
Which bacteria are commonly associated with septic arthritis?
- Staph aureus (MOST COMMON) | - Group A and B streptococci
50
Describe the pharmacological management of septic arthritis
- Commence Abx (guided by MC+S) and stop any immunosuppression, e.g. DMARDs, temporarily - Analgesia
51
Describe the interventional management of septic arthritis
Surgical joint washout if symptoms persist despite pharmacological therapy
52
What does SLE stand for and what is it?
SLE = systemic lupus erythematosus Lupus is a chronic inflammatory autoimmune condition that causes inflammation of the joints, skin and other organs
53
Describe the pathophysiology of lupus
- Type 3 hypersensitivity reaction | - Causes deposition of immune complexes in different body tissues leading to inflammation
54
What are the symptoms and signs of lupus?
Symptoms: - Fatigue - Arthralgia/myalgia - Chest pain - SOB - Photosensitivity Signs: - Pale mucous membranes (anaemia) - Oral ulcers - Malar rash - Discoid rash
55
How is lupus investigated?
Bloods: - FBC: anaemia - ESR/CRP raised - Autoantibody screen (many different ones present, e.g. ANA, anti-dsDNA, antiphospholipid antibodies - Biopsies of kidney and skin - show deposition of IgG and complement
56
Describe the conservative management of lupus
Avoid sunlight
57
Describe the pharmacological management of lupus
- NSAIDs for pain | - Immunosuppression, i.e. steroids and DMARDs
58
Give some common complications of lupus
- CVD - Depression - Osteoporosis

Phase 2a (16 decks)

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