MSK Flashcards
** Septic arthritis
- Septic arthritis – serious infection of ONE synovial joint space
- (75% knee>hip>ankle) → bone destruction in < 24hrs
- Staph.aureus (single site) or HiB (multiple site) or - Gonorrhoea (sexually active young pt.)
May result from adjacent osteomyelitis, haematogenous spread/ puncture wound
RF: steroids, RA, immunosuppressed, IVDU, prosthetic joint, DM
CF: Joint- swollen, erythematous, hot, tender, STUFF
Systemic: fever, rigors, vomiting, hypotension
IVX: ASPIRATE joint space then IV abx after, bloods + cultures, USS deep joints, bone scan and
TX: ABX, Flucoxacillin, refer to orthopaedics, physio and splint
** Temporal arteritis
also known as Giant cell arteritis
- Immune mediated granulomatous vasculitis of medium and large vessels
Typically in FEMALE pts > 55yo; If younger and FEMALE < 55 = Takayasu’s (aorta)
50% associated with Polymyalgia rheumatic
CF: Tends to be a RAPID onset < 1 month
Diffuse + constant HEADACHE (U/L ~ 85%) Superficial pain over temporal region ⇒ Scalp tenderness Jaw claudication – worse after eating Distended + throbbing temporal.a Acute transient visual loss (10%) ⇒ Amaurosis Fugax (curtain descending, 2o optic neuritis
IVX: ESR >50 !!!!!
CRP raised
Temporal artery biopsy - definitive dianosis = multinucleated giant cells - charatersitc skip lesions
Normocytic anaemia
Management: Steorids= Give immediatyely, HIGH DOSE 40MG PREDNISOLONE
+ Aspirin 75mg + PPI
- Urgent referral to opthalomolgy
Complication: stroke, TIA, optic neuritis
** Spinal Cord Compression
Spinal tumour, metastasis or crush fracture → direct spinal cord pressure or induction of vertebral collapse
1) Typically Thoracic (66%), also cervical and lumbar (33%) Often 1st presents in emergency department
Oncological, MSK trauma and inflammatory causes
CF: Back pain, noctural, aggravated by straining/coughing, motor pain and weakness, paraesthesia + saddle anaesthesia, bowel/bladder dysfunction.
IVX: Neuro exam, reflexes, clonus, palpate spine and abdo and ANAL TONE.
TX: A-E,
= Dexamethasone 16mg with PPI cover
URGENT MRI, radiotherapy and decompression surgery
Ifi motor function lost for 48hrs - unlikely recovery (paraplegia)
Osteoarthritis
Diagnostic?
X ray signs: LOSS
common sites
= PIPJ and DIPJ alongside base of thumb = squaring.
- Clinical syndrome characterised by destruction of joint cartilage + underlying bone (wear and tear) with a/ inflammation → eventual remodelling and disorganisation
Typical onset >45 yo, M=F, HIP AND KNEE
CF: Uilateral, large weight bearing joints- pain and crepitus worse at end of day.
stiffness after prolonged rest
Heberdens and Bouchards (hb pencil)
Diagnose: >45, no morning related stiffness longer than 30 mins
IVX: x-ray -LOSS Loss of joint space Osteophytes Subarticular sclerosis Subchondrial cysts
TX: exercise, weight loss + analgesic ladder
- Intrarticlar steroid injections
Hip/ Knee replacement
Osteoporosis
Number on dexa scan diagnositc?
Treatment + when to take
–Reduced bone mass
↑Risk of fragility fractures
Primary = age-related, FHx, prolonged immobility
Secondary (SHATTERED) = Steroids, Hyperthyroidism/ Parathyroidism, Alcohol + tobacco, Thin (BMI < 22), ↓Testosterone, Early menopause, Renal or liver failure, Errosive/inflammatory bone disease, Diet (↓Ca2+)
F > M
CF: Fragility fractres / asymtomatic
IVX: X ray + DEXA scan <2,5 is osteoporosis
Bloods: TFT, Ca, ALP, Po4
Osteoporosis is commonly associated with normal blood test values
Management
- lifestyle excises
- Bisphosphonates ALENDRONATE (standing 30 mins before breakfast)
Calcium Vit D
Rheumatoid Arthritis
Name of classification?
Treatment?
- Chronic, systemic, INFLAMMATORY JOINT DISEASE
RF: Smoking, Poor dental hygiene, FEMALE, Age > 50/60, HLA DR4/DR1 linked
CRITERIA for ∆ = ACR-EULAR RA classification (≥ 6 = ∆)
CF: relapsing remitting flares of small joints, worse in morning,
morning stiffness > 60 mins, fatigue, weight loss, bursitis
Late signs: Ulnar deviation, swan neck, RA nodules
Lung syx: fibrosing alveolitis, pleural effusion, vasculitis
Bloods: RH facture and anti-CCP
X RAY RANDS + FEET
TX: MDT rheumatologist, physio, podietry NSAIDS + prednisolone for flares - DMARDS: Methotrexate and + one other dmard e.g hydroxychloroquine \+ monoclonal antibody Surgery if pain/deformity
Annual review for complications
Polymyalgia Rheumaticia
Trouble doing what?
- Not a true vasculitis (pathogenesis unknown)
- -> PMR and GCA share the same demographic characteristics
CF: Sub-acute onset (<2 weeks proximal joints- shoulder and pelvic girdle aching and morning stiffness, fatigure, fever, weight loss, depression, carpal tunnel
Trouble lifting arms above head!!
IVX: CRP, ESR,
TX: IV METHYLPREDNISOLONE
Prednisolone 15mg o/d 2 years
Gastric PPI and bone protective bisphosphonate
(if markers dont decrease = not PA)
Review 3 monthly
Gout
- Deposition of Monosodium URATE crystals –> acute monoarthropaty and severe joint inflammation
- MTP bog toe
Causes: high purine diet, alcohol, CKD, Starvation, infection, M>F
CF: PAIN, localised, swollen, fever, malaise
IVX: aspiral synovial fluid - crystallography
BLoods: Serum urate >360, ESR
Joint X ray
Management: Self limiting 7-10 days NSAID + PPI or Colchine if NSAID intolerant / prednisolone
Long term: Allopurinol 2 weeks after acute attack
Vasculitis
Antibody?
Treatment?
Inflammatin of blood vessel walls
Infective causes
Non infective:
- Large vessel: GCA, takayasu arteritis in aorta
- Medium: Kawasaki, polyarteritis nodosa
- Small: ANCA +ve microscopic polyangitis
CF: systemtic ever, malaise, myalgia, purpira, HTN, end organ ischamia
IVX: Bloods- ESR, CRP, ANCA (anchor and vessesls), - rheumatoid factor
- Urine MSc
- Imaging: angiography + biopsy
Management: CYCLOPHOSPHAMIDE if ANCA +ve
TNF Blocker
Systemic Lupus Erythematosus (SLE)
Multi-system, autoimmune, inflammatory disorder characterised by formation of auto-Abs to various auto-Ag (e.g. ANA) → deposition of immune complexes –> tissue damage
CF: Malaise, Fatigue, Fever, MYALGIA + ARTHRALGIA ± Alopecia, Lymphadenopathy
Management: steroids + NSAID + DMARDS
Hydroxychloroquine (first line for mild SLE)
+ Suncream and sun avoidance for the photosensitive the malar rash
Fragility Fractures
Fragility fractures associated with osteoporosis are vertebral body, distal radius, NOF, pubic ramus, Neck of humerus
-
Ankylosing Spondylitis
Chronic, inflammaton of SPINE + SACROILIAC JOINTS → fusion of spine (bamboo)
- Males present earlier
CF: Typical young man with lower back pain + stiffness; gradual onset
Worse mornings. radiates to hips/buttucks
Relieved by exercise
Question mark ? deformity hunched back
+– Acute Iritis, Osteoporisis, Enthesitis (ligament inflammation)
IVX: X-ray /mri
Sacroilitits shows erosisons, Vertebral Ankylosis, syndesmophytes (bony growth inside a ligaments)
refer to Rheumatologist
Bloods: raised ESR, HLA +ve, normocytic anaemia
TX:
- Exercise, NSAIDS,
- IA Injections of corticosteroids
- TNF inhibitors for severe acute
- Surgery: Hip placement
Complication: Anterior Uveitis + cardiac complications such as heart block
Reactive Arthritis
? which syndrome?
Whats the triad?
Sterile inflammation - Sexually transmitted (chlamydia) - Post-dysteneric e.g. salmonella Triad of Reiters sydnrome typically 4 weeks post initial infeciton 1. Arthritis 2. Uveitis or conjunctivitis 3. Urethritis
Cant see cant pee cant climb a tree
IVX: ESR, CRP
Screen for chlamydial infection : MSI, NAATs
Stool culture if diarrhoea for salonella
Management: Split, NSAIDS, DMARD, Methotrexate
Usually resolves 3-12 months
Scleroderma
Increased Collagen deposition -> internal organ fibrosis –> Vasc Damage
limited vs diffuse
diagnosis
treatment
Reynaud’s – typically 1st symptom (90%)
Skin hardens – fingers (sclerodactyly)
- Inflammation 2. Microvascular dysfunction
- Fibrosis
Limited = CREST Calcinosis Raydnauds Esophogeal dysmotility Sclerodactyly Telangectasia
Diffuse version has cardio, lung and kidney issues too.
Diagnosis
- Nailfold Capillaroscopy
- ANA +ve, Anti-Scler 70 or anti-centromere
Treatment is very poor- try methotrexate
Sjorgrens syndrome
syx?
Diagnose with?
Dry mouth, Dry eyes, Fatigue and enlarged parotid gland
autoimmune
Anti-Ro and anti La ab + salivary gland biopsy.
