Osteoarthritis and Crystal Arthropathies Flashcards Preview

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Flashcards in Osteoarthritis and Crystal Arthropathies Deck (39):
1

What is osteoarthritis?

progressive degenerative condition affecting joints due to gradual thinning of cartilage, loss of joint space and osteophyte formation

2

What type of collagen is cartilage made up?

collagen type 2

3

What happens during the OA disease process?

loss of matrix, release of cytokines and meixed metalloproteinases as well as prostaglandins by the chondrocytes

4

Why are osteophytes produced in OA?

fibrillation of the cartilage surface which is then attempted to be repaired resulting in osteophytes

5

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)

6

What are the joints most commonly affected by OA?

neck; lower back; hips; base of thumb; ends of fingers; knees; base of big toe

7

What is seen in the hands during OA?

DP; PIP and 1st CMC joints affected. squaring of the thumb

8

What is a Heberden node?

bony enlargement at the DIP

9

What is a Bouchards node?

bony enlargement at the PIP

10

Where might hip pain in OA radiate to?

in the groin; knee; radiate from the lower back

11

Why might you get nervous pain in OA?

osteophytes in the spine may impinge on nerve root

12

What are the risk factors for OA?

age; female; occupation (heavy lifting etc); previous injury/joint abnormality; obesity; other underlying joint problems

13

What is seen on X-ray of OA?

joint space narrowing; subchondral sclerosis; bony cysts; osteophytes

14

What is seen on bloods in OA?

nothing- inflam markers normal

15

What are the non-pharma managment for OA?

education; PT; wt loss; footwear; aids

16

What are the pharma options for OA?

analgesia; NSAIDs; pain modulators eg tricyclics gabapentin; intra-articular steroids (only short term)

17

What crystals cause gout?

monosodium urate

18

What crystals cause pseudogout?

calcium pyrophosphate dihydrate

19

What is gout?

inflammatory arthritis assoc. with monosodium urate crystal deposition

20

Who is gout seen in?

most common inflam arthritis in men
more common in men
increases with age

21

What is hyperuricaemia defined as?

serum uric acid >7mg/dL

22

What is the pathophysiology of gout?

overproduction and/or underexcretion of uric acid

23

What can cause underexcretion of uric acid?

renal insufficiency; starvation; dehydration; hypothyroid;drug

24

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

25

What is the differential diagnosis of gout?

septic arthritis; trauma; seronegatvie arthritis

26

What is seen with chronic polyarticular gout?

chronic joint inflam; tophi after recurrent acute attacks

27

What is seen on bloods of acute gout?

inflam markers raised; raised WCC

28

What is seen on x-ray of acute gout?

chronic/repeated attacks- erosions, overhanging osteophytes, joint destruction

29

What is the gold standard for diagnosing gout?

joint aspiration

30

What is seen in the joint aspirate?

needle-shaped crystals, negative birefringence on polarised light microscopy

31

What is given in the managemnt of gout?

NSAIDs
colchicine
steroids

32

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)

33

What are the indications for gout prophylaxis?

>2 attacks; tophi; erosions on xray; renal stones

34

What are the urate lowering therapy?

allopurinol/ febuxostat

35

What are the crystals seen in pseudogout?

rhomboid/envelope shaped crystals with weakly positive birefringence

36

What are the treatments for pseudogout?

NSAIDs; colchicine; steroids; rehydration

37

What is hydroxyapatite?

milwaukee shoulder

38

What is milwaukee shoulder caused by?

hydroxyapatite crystal deposition in or around the joint- shoulder

39

Who is hydroxyapatite?

females, 50-60 years