Flashcards in Osteoarthritis and Crystal Arthropathies Deck (39):
What is osteoarthritis?
progressive degenerative condition affecting joints due to gradual thinning of cartilage, loss of joint space and osteophyte formation
What type of collagen is cartilage made up?
collagen type 2
What happens during the OA disease process?
loss of matrix, release of cytokines and meixed metalloproteinases as well as prostaglandins by the chondrocytes
Why are osteophytes produced in OA?
fibrillation of the cartilage surface which is then attempted to be repaired resulting in osteophytes
What are the symptoms seen in OA?
grad onset; mechanical pain; crepitus on movement; stiffness (less than 30mins); bony swelling and deformity of joints; effusions and soft tissue swellings (synovial thickening)
What are the joints most commonly affected by OA?
neck; lower back; hips; base of thumb; ends of fingers; knees; base of big toe
What is seen in the hands during OA?
DP; PIP and 1st CMC joints affected. squaring of the thumb
What is a Heberden node?
bony enlargement at the DIP
What is a Bouchards node?
bony enlargement at the PIP
Where might hip pain in OA radiate to?
in the groin; knee; radiate from the lower back
Why might you get nervous pain in OA?
osteophytes in the spine may impinge on nerve root
What are the risk factors for OA?
age; female; occupation (heavy lifting etc); previous injury/joint abnormality; obesity; other underlying joint problems
What is seen on X-ray of OA?
joint space narrowing; subchondral sclerosis; bony cysts; osteophytes
What is seen on bloods in OA?
nothing- inflam markers normal
What are the non-pharma managment for OA?
education; PT; wt loss; footwear; aids
What are the pharma options for OA?
analgesia; NSAIDs; pain modulators eg tricyclics gabapentin; intra-articular steroids (only short term)
What crystals cause gout?
What crystals cause pseudogout?
calcium pyrophosphate dihydrate
What is gout?
inflammatory arthritis assoc. with monosodium urate crystal deposition
Who is gout seen in?
most common inflam arthritis in men
more common in men
increases with age
What is hyperuricaemia defined as?
serum uric acid >7mg/dL
What is the pathophysiology of gout?
overproduction and/or underexcretion of uric acid
What can cause underexcretion of uric acid?
renal insufficiency; starvation; dehydration; hypothyroid;drug
What is the presentation of acute monoarticular gout?
rapid onset; red, hot joint; severe pain; duration- up to 2 weeks; site- 1st MTPJ>ankle>knee> upper limb> spine
What is the differential diagnosis of gout?
septic arthritis; trauma; seronegatvie arthritis
What is seen with chronic polyarticular gout?
chronic joint inflam; tophi after recurrent acute attacks
What is seen on bloods of acute gout?
inflam markers raised; raised WCC
What is seen on x-ray of acute gout?
chronic/repeated attacks- erosions, overhanging osteophytes, joint destruction
What is the gold standard for diagnosing gout?
What is seen in the joint aspirate?
needle-shaped crystals, negative birefringence on polarised light microscopy
What is given in the managemnt of gout?
What are the lifestyle modifications for gout?
restrict red meat; offal beans; shellfish
reduce alcohol; lost weight; lots of fluids- but not fizzy drinks with fructose (can be metabolised to purine)
What are the indications for gout prophylaxis?
>2 attacks; tophi; erosions on xray; renal stones
What are the urate lowering therapy?
What are the crystals seen in pseudogout?
rhomboid/envelope shaped crystals with weakly positive birefringence
What are the treatments for pseudogout?
NSAIDs; colchicine; steroids; rehydration
What is hydroxyapatite?
What is milwaukee shoulder caused by?
hydroxyapatite crystal deposition in or around the joint- shoulder