Osteoarthritis

Question 1

what is osteoarthritis

Answer 1

a chronic disease characterised by cartilage loss and accompanying periarticular change

Question 2

key pathological changes of OA

Answer 2

localised loss of hyaline cartilage and remodelling of adjacent bone with new bone formation at joint margins

Question 3

what triggers the need to repair

Answer 3

a variety of joint traumas

Question 4

risk factors for OA

Answer 4

genetic factors
ageing
female sex
obesity
joint injury
occupational usage 
reduced muscle strength 
joint laxity
joint malignancy

Question 5

what joints does localised OA affect

Answer 5

hips, knees, finger, facet joints of lower cervical and lower lumbar spines

Question 6

what joints does generalised OA affect

Answer 6

defined as OA at either the spinal or hand joints and in at least 2 other regions

Question 7

what is the clinical marker for generalised osteoarthritis

Answer 7

the presence of multiple heberden’s nodes

Question 8

what are heberdens nodes

Answer 8

boney swellings at fingers

Question 9

what type of joints are affected by OA

Answer 9

synovial

Question 10

OA presentation

Answer 10

pain - worse with joint use
morning stiffness lasting less than 30 mins
inactivity gelling
instability
poor grip in thumb OA

Question 11

examination features of OA

Answer 11

• joint line tenderness
• crepitus
• bony swelling
• deformity
• limitation of motion

Question 12

presentation of cervical spine OA

Answer 12

pain and restriction of movement

occipital headaches may occur

Question 13

presentation of lumbar spine oa

Answer 13

osteophytes can cause spinal stenosis if they encroach on the spinal canal

Question 14

diagnosis of OA

Answer 14

clinical history
plain X-rays
MRI scans
ultrasound scans

Question 15

what would be seen on X-ray in OA

Answer 15

marginal osteophytes
joint space narrowing
subchondral sclerosis
subchondral cysts

Question 16

management of osteoarthritis

Answer 16

education
lifestyle management 
physiotherapy occupational therapy
analgesia
local intra-articular steroid injections

Question 17

surgical management for OA

Answer 17

joint replacements

arthroscopic surgery to remove loose bodies

Question 18

what are crystal arthropathies

Answer 18

they are a diverse group of disorders characterised by the deposition of various minerals in joints and soft tissues leading to inflammation

Question 19

what is gout

Answer 19

a potentially disabling and erosive inflammatory arthritis caused by the deposition of monosodium urate crystals into joints and soft tissues

Question 20

causes of hyperuricaemia

Answer 20

increased urate production

reduced urate excretion

Question 21

what can cause increased urate production

Answer 21

• inherited enzyme defects
• myeloproliferative/lymphoproliferative disorders
• psoriasis
• haemolytic disorders
• alcohol
• high dietary purine intake

Question 22

causes of reduced urate excretion

Answer 22

• chronic renal impairment
• volume depletion
• hypothyroidism
• diuretics
• cytotoxics

Question 23

presentation of acute gout

Answer 23

MTP joint - ankle, knee
settles in about 10 days without treatment - 3 days with treatment
abrupt onset, often overnight

Question 24

chronic tophaceous gout

Answer 24

chronic joint inflammation
often diuretic associated 
high serum uric acid 
tophi
may get acute attacks

Question 25

gout investigations

Answer 25

``` serum uric acid raised raised inflammatory markers polarised microscopy of synovial fluid renal impairment x-rays ```

Question 26

how do you treat acute gout

Answer 26

NSAIDs colchicine steroids

Question 27

preventative measures for gout

Answer 27

- Xanthine oxidase inhibitors - allopurinol, febuxostat - uricosuric drugs - sulfinpyrazone, probenecid, benzbromarone - IL-1 inhibitors - canakinumab, start 2 weeks after acute attack, requires cover with NSAIDs

Question 28

what are the indications for prophylactic therapy

Answer 28

1) two or more attacks of gout in year despite lifestyle change 2) presence of gouty tophi or signs of chronic gouty arthritis 3) uric acid calculi 4) chronic renal impairment 5) heart failure where unable to stop diuretics 6) chemotherapy patients who develop gout

Question 29

what is the target uric acid level for gout

Answer 29

300-360umol/L

Question 30

what does calcium pyrophosphate deposition disease affect

Answer 30

fibrocartilage | -knees, wrists, ankles

Question 31

causes of CPPD

Answer 31

``` ageing osteoarthritis hyperparathyroidims gout trauma familial hypocalciuric hypercalcaemia hemochromatosis hypomagnesemia hypothyroidism amyloidosis ```

Question 32

treatment for CPPD

Answer 32

NSAIDs colchicine steroids rehydration

Question 33

what is hydroxyapatite

Answer 33

hydroxyapatite crystal deposition in or around the joint | release of collagenases, serine proteases and IL-1

Question 34

treatment for hydroxyapatite

Answer 34

NSAIDS intra-articular steroid injection physiotherapy partial or total arthroplasty

Question 35

what is soft tissue rheumatism

Answer 35

general term to describe pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerve near a joint rather than bone or cartilage

Question 36

what is the commonest area for soft tissue pain

Answer 36

the shoulder

Question 37

investigations for soft tissue problems

Answer 37

X-ray - calcific tendonitis MRI if fails to settle identify precipitating factors

Question 38

management for soft tissue problems

Answer 38

``` pain control rest and ice compressions PT steroid injections surgery ```

Question 39

symptoms of joint hypermobility

Answer 39

``` join pain especially after exercise joint stiffness foot and ankle pain neck and backache frequent sprains and dislocations thin stretchy skin ```

Question 40

what does the modified beighton score measure

Answer 40

hypermobility

Question 41

treatment for hypermobility

Answer 41

- education - physiotherapy - analgesia - surgery not recommended