MSK Flashcards
(116 cards)
1
Q
prevalence of rheumatoid arthritis
A
1% prevalence
2
Q
Risk factors and age affected of RA
A
40 - 60 YO
Female
family history
other autoimmune conditions
3
Q
what is rheumatoid arthritis
A
chronic autoimmune inflammatory conditon
4
Q
Typical presenation of RA
A
Slow onset
Symmetrical peripheral polyarthropathy
pain and stiffness in small joints, MetaCarpoPhalangeal MCP, metatarsophalangeal MTP, distal and proximal interphalangeal, DIP, PIP
pain is significantly worst in the morning and gets better throughout day, worst after rest.
knees hips elbows shoulders, less common
responds to NSAIDS
5
Q
signs of RA
A
bony swelling. swelling in synovium of dip pip MCP MTP, often symmetrical
tenosynovitis (tendon stiffness) or bursitis (inflammation of bursa)
Rheumatoid nodules- nodules under skin, near joints. painless
Ulnar deviation
boutonniere
swan neck deformity
muscle wasting
6
Q
X ray signs of RA
A
soft tissue swelling periarticular bone thinning, osteopenia joint space narrowing bony erosions JOES
7
Q
histological finding of RA
A
Pannus
8
Q
extra articular effects / complications of RA
A
Pericarditis pleural effusion pericardial effusion nerve entrapment dry eyes anemia septic arthritis
9
Q
diagnosis and investigations of RA
A
Serology- Anti CCP diagnostic, also find rheumatoid factor and anti nuclear antibodies
Bloods- ESR CRP and anemia
x ray
10
Q
diagnostic criteria of RA
A
Small joint involvement
serology present
increase in acute phase proteins, and inflammatory markers, ESR, CRP
chronic duration
11
Q
early signs of RA
A
fatigue malaise swelling,
pain of inflammatory nature
12
Q
management for RA
A
first start with symptomatic management of pain - NSAIDS
once pain managed start on DMARD within 3 months
treat flare ups of RA
surgery for entrapment complications
monitor complications
physio
13
Q
How to treat RA flare ups
A
steroids, Intra Articular methylprednisolone or Dexamethasone.
or oral prednisolone not for long term use
14
Q
What is a DMARD
A
Disease modifying antirheumatic drugs, steroid sparing drugs, cytokine inhibition to reduce inflammation Methotrexate
used to induce remission then dropped down to maintain remission
sulfasalazine, hydroxychloroquine
15
Q
other than methotrexate, what other DMARDs are available
A
sulfasalazine
hydoxychoroquines
16
Q
what is used to treat RA after DMARDs,
A
biological agents
B cell depletion rituximab
TNF alpha inhibition - infliximab
17
Q
Further management and managing complications of RA
A
DEXA scan for Osteoporosis
control CVA risk, since having constantly increased CRP can form atheromas
refer to physio - manage activities of daily living
joint hip replacement
18
Q
osteoarthritis prevalence
A
commonest joint disorder
50% of those over 65 are symptomatic
80% show X ray signs
19
Q
osteoarthritis risk factor
A
Age biggest one trauma obesity occupation female genetic predisposition previous joint involvement or arthropathy
20
Q
pathophysiology of OA
A
Loss of cartilage
disordered bone repair
has an inflammatory component
21
Q
clinical features of OA
A
hip and knee most commonly effected
not always symptomatic but may show on X ray
can have flare ups with increased CRP and ESR
22
Q
symptoms of OA
A
Joint pain is presenting complaint, hips or knees. gets worst as use throughout day. worst in mornings and after rest
doesn’t get better with NSAIDS
joint stiffness
loss of function
23
Q
signs of OA
A
joint instability crepitus alteration of gait boney swelling (effusion, synovitis) joint tenderness cracking limited range of movement Heberden's nodes - DIP swelling Bouchard's nodes - pip swelling
24
Q
Investigations for OA
A
Serology ANA RF Anti CCP -VE ESR CRP normal CRP may be elevated X Ray of OA aspiration of fluid if its present
25
X Ray finding of OA
```
LOSS
loss of joint space
osteophytes
subchondral cyst
subchondral sclerosis
```
26
Conservative Management of OA
Conservative, education, weight loss, physio and exercise. walking aids. insoles hot or cold packs
27
pharmacological management for OA
paracetamol and topical NSAIDS, or gel.
if painful joint effusion- corticosteroid injections
subtype inflammatory RA- DMARDs
28
Surgical management of OA
arthroplasty, knee or hip replacemnt
| arthroscopy for loose body fragments
29
what are the 2 types of Crystal arthropathy and their composition
Gout: uric acid
Pseudogout: Calcium phosphate
30
presentation of acute gout
severely inflamed , Red Hot Swollen Painful,
monoarthropathy,
usually MTP of big toe
31
Investigation of gout
Joint fluid aspirate is gold standard.
polarised light microscopy
need to exclude septic arthritis
32
what do the results of polarised light microscopy indicated
-Ve birefringent needle - uric acid
| weakly +ve birefringent needles - pseudogout, Calcium phosphate
33
what can cause gout attack
high uric acid, consumption of high purine food. dehydration or diuretics
suddenly stopping medication
alcohol shellfish
hereditary
34
treatment of acute gout
NSAIDs, or colchicine
| can use intraocular steroid injections
35
prevention of gout attack
| treatment of chronic gout
```
educations on what can precipitate gout and how to avoid it
avoid low dose aspire
avoid alcohol, long fast,
loss weight
xanthine oxidase inhibitor-allopurinol
```
36
treatment of chronic gout
```
educations on what can precipitate gout and how to avoid it
avoid low dose aspire
avoid alcohol, long fast,
loss weight
xanthine oxidase inhibitor-allopurinol
use NSAIDs or Colchicine
```
37
X ray changes on chronic gout
Punched out cortex
38
calcium pyrophosphate deposition / pseudogout features
| presentation, where and what triggers it
similar to gout presentation but more common in larger joints like- MCP, Wrist knee ankle
triggered by trauma or unprovoked
39
calcium pyrophosphate deposition / pseudogout management
NSAIDs or colchicine
intra-articular steroid injection
joint aspirate
40
association of pseudogout CPPD
Haemochromatosis, hyperparathyroidism
41
associations for gout
DM, hypertension, heart or renal diseae
42
features of chronic gout
excess uric acid deposition throughout forming tophi
43
Prevalence of gout
commonest cause of arthritis in men <40 YO
| 1%
44
what type of collagen is in cartilage
type 2 collagen
45
osteoporosis pathophysiology
Systemic skeletal disease caused by reduced bone mineral density. osteoclasts breakdown bone
osteoblasts build up bone
osteoporosis is increased osteoclasts and reduced osteoblasts
46
causes risk factors and associations for osteoporosis
Age, increased time the bone remodeling isn't as well
post menopause, oestrogen Inhibits osteoclast activity
long term glucocorticoids- increase bone resorption
cushing's disease
hyperparathyroidism
Hyperthyroidism
Inflammatory conditions - RA, IBD, due to increased cytokines and inflammation causing increased resorption
reduced skeletal loading, bed bound for ages
family history
47
first sign/ symptom of osteoporosis
```
usually the fracture,
vertebre - not due to trauma, picking something up
hip
knee
in order of likeness
writs ankle etc
```
48
Investigations for osteoporosis
DEXA scan - dual energy X Ray absorption - mesures bome mineral denisty and generates a T Score
49
Diagnostic criteria for osteoporosis
T-Score> - 1 normal
T-Score= -1 - -2.5 osteopenia
T-Score
50
investigation used to assess likelihood of sustaining a hip fracture in next 10 years
FRAX
51
Treatment conservative for Osteoporosis
```
physio exercises (weight bearing), walking aids prevent falls.
stop smoking and reduce alcohol less than 3 units a week.
```
52
Pharmacological treatment for Osteoporosis
Vitamin D and calcium ADCAL.
antiresorptives- Bisphosphonates, reduce osteoclast activity.
Alendronic acid
potentially HRT
anabolic - PTH analogues teriparatide
53
what are the side effects of HRT
increased risk of breast cancer, stroke and CV disease
54
what is polymyalgia rheumatica
Large cell vasculatis, causing sudden onset of severe pain in shoulders and neck stiffness. worst in morning and comes from 30 mintes to hours. usually patients over 50
CRP and ESR elevated
55
what does "sudden onset of sevre pain in shoulders and neck stiffness, lasting 30 mins to hours in over 50 YO patients suggest
Polymyalgia rheumatica
56
what is giant cell artheritis and what does it affect
LArge cell vasculitis of inflammatory granulomatus arteries affecting aorta but also Extra cranial branches of carotid arteries.
57
Epidemiology of GCA
assosiated with PMR in 50%. always over 55
| commonly in women
58
Symptoms of GCA
Jaw claudication
facial pain
headache
WORST symptom- temporary blindness or visual loss in one eye
59
signs of GCA
Temporal artery tenderness
| scalp tenderness
60
investigations of GCA
bloods, CRP and ESR
| Temporal Artery Biopsy - diagnostic
61
Diagnoses of GCA
```
over 50 YO
new headache
temporal artery biopsy (shows granulomatous inflammation) (individually diagnostic)
high ESR
Temporal artery tenderness
```
62
Treatment for GCA
corticosteroids for 2 years, prednisolone
considerer DMARDs
DEXA scan, Adcal and potentially bisphosphonates
63
what is betchets disease
Vasculities of the whole body
| ANCA positive
64
what is goodpastures syndrome
pulmonary vasculitis
| ANCA positive
65
what is fibromyalgia
long term condition causing widespread body pain
66
Prevalence and epidemiology of fibromyalgia
4% 10F=M
| Female, middle aged, divorced, low household income
67
symptoms of fibromyalgia
wise spread pain, muscle stiffness, insomnia and difficulty sleeping, fatigue, extreme tiredness, sensitivity to pain
68
signs of fibromyalgia
signs of tenderness
| no signs of inflammation
69
Investigations of fibromyalgia
all tests return negative
| exclude RA Myeloma Infection PMR
70
association of fibromyalgia
IBS, Chronic fatigue, Headache
71
Managment of Fibromyalgis
Talking therapy, couciling CBT
Analgeisa and analgesic ladder, Tramadol
antidepressants may help amitriptyline
SSRI dont work too well
72
what is systemic lupus erythematosus
Autoimmune connective tissue disorer
73
pathophysiology of SLE
disease causes inflammation which causes scarring of tissue leading to organ failure. most commonly skin, joints kidney, lungs, blood cells
antibody mediated immune response
74
epidemiology of SLE
0.2% prevalnce.
| 14-64 age group with commonest 20-40 onset
75
clinical features of SLE and tissue commonly effected
```
relapsing remitting illness. most patients suffer fatigue, fever, arthralgia and skin problems (facial lupus rash)
affects skin
lungs
joints
heart
kidney
```
76
SLE, clinical features of skin
Commonest and often earliest sign of SLE
Erythema (Malar) rash, photosensitive rash
purpura and urticaria, discoid rash (commonest rash)
alopecia
raynaud's phenomenon
77
SLE, clinical features of lungs
Pleurisy, pleurisy
78
SLE, clinical features of joints
arthralgia, symmetrical, non erosive
79
SLE, clinical features of heart
Pericarditis, Pericardial effusion, increased risk of clotting
hypertension
80
SLE, clinical features of kidney
glomerulonephritis, can develop into haematuria and proteinuria
81
Investigations and diagnosis of SLE
FBC: Anemia, thrombocytopenia, neutropenia, lymphopenia (basically everything is low)
ESR, CRP high
serology: ANA +ve, anti DsDNA (diagnostic)
```
Other tests (help assess severity)
U and E - elevated
Dipstick - haematuria
CXR - effusion
ECG - pericarditis
```
82
4 results that can make you suspect SLE
```
Presence of ANA
Presence of anti DsDNA
Arthritis/ arthralgia
Discoid Rash
renal dysfunction
```
83
Different rashes in SLE
Malar rash (erythema) malar means cheek, erythema means redness
Discord Rash
Photosensitive rash
84
Management of SLE
Conservative
maintenance
Flare ups
normal management - Hydroxychloroquine (anti-Malarial) +NSAIDs. if not managed use methotrexate or steroids
Flare ups- Corticosteroids or prednisone + NSAIDs, Topical steroids
Conservative, educate on smoking cessation diet exercise and Photosensitive rash, Screen major organ damage.
85
what is seronegative spondyloarthropathy
different types
Epidemiology
a group of related inflammatory conditions which affect spine and peripheral joints and are limited by HLA genes.
they are seronegative so test -ve for RF, ANti CCP
presents in younger populations and is more limited than RA
spondylosing ankylosis
psoriatic arthritis
reactive arthritis
86
what is Ankylosing Spondylosis
chronic inflammatory disorder of spine and sacroiliac joints
87
epidemiology of ankylosing spondylosis
1% prevalence
affects men more
average onset is <30 YO
often presents early teens to twenties
88
Clinical features of Ankylosing spondylosis
```
gradual onset of lower back pain
worse at night
stiff in morning
relieved by exercise
pain radiating from sacroiliac joint to buttocks and hips
chronic back pain
```
89
diagnostic criteria for ankylosing spondylosis
```
chronic back pain, under 50 YO. has 3 of the following:
morning stiffness
worst at night- wakes them up
alternating buttocks pain
back pain improves with exercise
```
90
what is the name of the connective tissue between tendon or ligament and bone
enthesis
91
othey symptoms of ankylosing spondylosis
inflammatory back pain
enthesitis
Dyspnoea, due to costochondritis
IBDs
92
complications of AS
```
Kyphosis
osetoporosis
chostochondritis
enthesis
iritis
```
93
Investigation of AS
any inflammatory back pain, sacroilliac XRay showing sacrolillitis
ultrasound shows enthesis
FBC, CRP and ESR
HLA B27
94
Management of AS
conservative, physio exercise, preventative exercise.
drugs- NSAIDs when requires + PPI
if severe- Intra Articular steroids
if enthsis, TNF A blocker- infliximab
surgery, Hip replacement if needed
95
Prognosis of AS
80% lead normal life just on exercise regime and NSAIDs
96
what is psoriatic arthritis
a type of seronegative spondyloarthritis
| less severe than RA
97
Presentation of psoriatic arthritis
```
symmetrical polyarthropathy
commonly affecting DIP
synovitis
joint pain and stiffness
Dactylitis
80% of the time has finger nail changes (
40% of the time associated with psoriasis
scalp tenderness or scalp problems
```
98
nail changes in psoriatic arthritis
```
brittle nails
white spots (leukonychia)
onycholysis (finger nail separating from bed)
Pitting (commonest sign)
splinter haemorrhage
```
99
Investigations of psoriatic arthritis
X RAY- shows bone erosions in DIP, pencil in cup deformity
CRP elevated
Seronegative
synovial fluid aspirate
100
Treatment of Psoriatic arthritis
NSAIDs and analgesia
if more severe use DMARDs or Infliximab
intra articular steroid injections for flare up
101
what is Reactive arthritis
arthritis that develops after infection, typically 4 weeks
| usually dysentery or GU Infection
102
what causes reactive arthritis
GU infection like chlamydia
| dysentery salmonella shigella
103
Presentation of reactive arthritis
```
systemic features like fever
axial or peripheral arthritis
peripheral asymmetric polyarthritis (typically larger joints of lower limbs)
enthesitis
nail dystrophy
dactylitis
conjunctivitis
skin rash and balantitis
```
104
Investigations of Reactive Arthritis
cultures- stool and GU, usually -ve due to RA happening after infection
esr and CRP increased
Rf and ANA serology -ve
xray shows enthesitis
105
Management of Reactive arthritis
NSAIDs,
Intra Articular steroids
DMARDs
106
What is sepric arthritis
Infection in the synovium of the joint, either via direct or via blood
107
septic arthrtits presentation and which joints
Red Hot Swollen Painful. similar presentation to crystal arthropathy
Most commonly affects knee 50% of cases
108
causes of septic arthritis
staph aureus, streptococci, neisseria gonococcus
gram -ve in Immunosuppressed or older patients
gets in via infection, post surgery , immunosuppressed TB, Infected Skin, Indwelling IV lines
109
epidemiology of septic arthritis and risk factors
```
commoner in RA and pre existing joint conditions
immunocompromised
DM
prosthetic joint replacement
IVDU
over 80 YO
recent surgery
```
110
Investigation of septic arthritis
Joint asperation for Microscopy and cultures
| CRP Xray maybe normal may be elevated or shows degeneration
111
Management of septic arthritis
start IV antibiotic immediately
use IV vancomycin (gram +ve) or Cefotaxime (gram -ve)
+joint aspirate
112
what is osteomyelitis and what causes it
Inflammation of a bone due to an infectious agents commonly Staph aureus
113
what can cause osteomyelitis
s aures or group B streptococci
| recent open fracture or orthopaedic surgery. also immunocompromised or very young. IVDU
114
osteomyelitis presentation
```
non specific pain at infection site
malaise and fatigue
local inflammation
fever
presence of risk factors, Scars indicating surgery or fracture
```
115
osteomyelitis investigation
ESR CRP and WCC are raised
Xray will show osteomyelitis, bone destruction
can have MRI - which is very helpful
116
management of osteomyelitis
High dose antibiotics
| consider surgery if chronic (bone is dead)
