Osteoarthritis and crystal arthropathies

Question 1

What differences are there in a normal synovial joint and an osteoarthritic joint?

Answer 1

Inflammation of synovial membrane, articular cartilage failure, loss of joint space

Question 2

What is the pathogenesis of osteoarthritis?

Answer 2

Loss of cartilaginous matrix, release of IL1 and TNF cytokines which results in fibrillation of the cartilage surface.

Question 3

What are the two types of ostearthritis?

Answer 3

Idiopathic

Secondary

Question 4

Where does idiopathic osteoarthritis most commonly affect?

Answer 4

Hands, feet, knee, hip, spine.

Question 5

What can cause secondary osteoarthritis?

Answer 5

Previous injury,
RA
Acromegary

Question 6

What are the risk factors for developing osteoarthritis?

Answer 6

Older, 
Female, 
Obesity, 
Sports, 
Previous injury

Question 7

What are the symptoms of osteoarthritis?

Answer 7

Pain worse on activity and relieved by rest

Stiffness in the morning.

Question 8

On examination, what do you expect to find in a osteoarthritis positive patient?

Answer 8

Joint tenderness
Joint effusion
Crepitus
Bony enlargements

Question 9

Where does osteoarthritis tend to affect?

Answer 9

Hip, knee, MTP joints in foot, cervical and lumbar spine.

Big toe.

Question 10

What are enlargements at the distal interphalangeal joints called?

Answer 10

Heberdens nodes

Question 11

What are enlargements at the proximal interphalangeal joints called?

Answer 11

Bouchards nodes

Question 12

How is osteoarthritis diagnosed?

Answer 12

On x-ray:
loss of joint space
subchondral sclerosis
subchondral cysts

Question 13

What blood findings differentiate RA from osteoarthritis?

Answer 13

RA has positive rheumatoid factor and a positive anti-CCP Ab.
Osteoarthritis has normal CRP and ESR

Question 14

What is the non-pharmalogical management process of osteoarthritis?

Answer 14

Physiotherapy
weight loss
Exercise
Trainers

Question 15

What drugs can be used to treat osteoarthritis?

Answer 15

Analgesia
NSAIDs- need to balance risk
Amitriptyline, gabapentin

Question 16

What intra-articular injections can be given?

Answer 16

Steroids- main one

Hyaluronic acid

Question 17

What surgical procedures can be given as management for osteoporosis?

Answer 17

Arthroscopic washout (not routine)
Joint replacement.

Question 18

What would you expect to find within the synovial capsule?

Answer 18

Synovial fluid

Question 19

What is gout?

Answer 19

Inflammation in the joint, triggered by uric acid crystals.

Question 20

Which sex is gout more common in?

Answer 20

Male

Question 21

What is uric acid?

Answer 21

Uric acid is the final compound in breakdown of DNA metabolism.

Question 22

What factors cause hyperuricaemia?

Answer 22

Alcohol
High dietary purine intake- red meat, seafood
Psoriasis
Haemolytic disorders
Hypothyroidism
Diuretics

Question 23

Where does gout normally affect?

Answer 23

1st metatarsal phalangeal joint- big toe
Then the ankle
then the knee

Question 24

How long does it take for gout to resolve itself?

Answer 24

10 days

Question 25

Does gout have an acute or chronic onset?

Answer 25

Sudden. | Usually over night.

Question 26

What affect does osteoporosis have on osteoarthritis?

Answer 26

Seems to have a protective effect.

Question 27

What affect does rheumatoid arthritis have on osteoarthritis?

Answer 27

Can contribute to osteoarthritis. | Osteoarthritis CAN NOT cause RA.

Question 28

What is chronic tophaeceous gout?

Answer 28

Chronic joint inflammation which can have acute attacks. Often diuretic associated Has high serum uric acid.

Question 29

What investigations would you do if you suspected gout?

Answer 29

Serum uric acid (may be normal!) CRP, ESR Joint aspiration x-ray

Question 30

What is the treatment for an acute attack of gout?

Answer 30

NSAIDs Colchicine Steroids.

Question 31

What is the prophylactic treatment of gout?

Answer 31

Allopurinol Febuxostat Need to cover with NSAIDs or colchine.

Question 32

What is important to note in giving febuxostat?

Answer 32

Needs to have liver function tests every 6 months Rare analphylaxis and Steven-Johnson's syndrome Caution in transplant patients

Question 33

What is calcium pyrophosphate deposition disease?

Answer 33

Pseudogout.

Question 34

Where does calcium pyrophosphate deposition disease affect?

Answer 34

Affects fibrocartilage i.e. knees, wrists, ankles.

Question 35

How would you treat calcium pyrophosphate deposition disease?

Answer 35

NSAIDs Colchine Steroids rehydration

Question 36

What investigations would you do if you suspected osteoarthritis?

Answer 36

No lab tests. | History, exam and x`-ray.

Question 37

At what mmol/L does uric acid become insoluble?

Answer 37

0.42

Question 38

What is Milwaukee shoulder?

Answer 38

Hydroxypatite crystal deposition around the joint.

Question 39

Who is Milwaukee shoulder most common in?

Answer 39

Females 50-60

Question 40

What treatment can be given for Milwaukee shoulder?

Answer 40

NSAIDs Intra-articular steroids Physio

Question 41

What is soft tissue rheumatism?

Answer 41

General term that describes pain that is caused by damage to ligaments, tendons, muscle etc.

Question 42

Where would a soft tissue rheumatism affect?

Answer 42

In a localised, specific site. If not `then consider fibromyalgia.

Question 43

On x-ray in osteoarthritic patient, what are you expecting to see?

Answer 43

L - loss of joint space O - osteophytes S - sclerosis (whiter) S - subchondral cysts