Osteoarthritis and Crystal Arthropathies

Question 1

most common form of arthritis?

Answer 1

osteoarthritis

Question 2

pathogenic effects of osteoarthritis on bone?

Answer 2

formation of osteocytes
loss of joint space
thinning of cartilage
bony swelling

Question 3

does cartilage grow back?

Answer 3

no

Question 4

how does cartilage thin?

Answer 4

loses its matrix

Question 5

why are osteocytes present?

Answer 5

in an attempt to repair broken down cartilage

Question 6

what kind of pain does osteoarthritis present with?

Answer 6

mechanical pain i.e worse on activity, worse at end of day

Question 7

is osteoarthritic pain relieved by rest or exercise?

Answer 7

rest

Question 8

how long are joints typically stiff for?

Answer 8

<30 mins

Question 9

most common areas affected by osteoarthritis?

Answer 9

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

Question 10

which part of the hands are most affected by osteoarthritis?

Answer 10

DIP
PIP
1st CMC
base of thumb

Question 11

what are bony enlargements affecting the DIP joint called?

Answer 11

heberdens nodes

Question 12

what are bony enlargements affected PIP joint called?

Answer 12

bouchards nodes

Question 13

manifestations of osteoarthritis on the leg?

Answer 13

bakers cyst

genu varus

Question 14

where can hip pain typically be felt?

Answer 14

groin
hip
radiating knee

Question 15

where can hip pain be a referred pain from?

Answer 15

lower back

Question 16

what is a bakers cyst?

Answer 16

lump in popliteal fossa from drained effusion from joint

Question 17

risk factors for OA

Answer 17

age>40
female
genetic
job involving strain
previous injury
obesity
MSK comorbs

Question 18

what joints does RA tend to affect?

Answer 18

MCP

PIP joints

Question 19

how do the joint characteristics of RA differ from OA

Answer 19

RA= soft, warm, tender
OA= cold, hard, bony

Question 20

what would be the result of ESR and CRP for OA

Answer 20

normal

Question 21

what would the anti CCP antibody result be for OA

Answer 21

negative

Question 22

what would the result of ESR and CRP be for RA

Answer 22

raised

Question 23

what would the anti CCP antibody result be for RA

Answer 23

positive

Question 24

is the treatment for OA curative?

Answer 24

no

Question 25

treatment for OA?

Answer 25

analgesics NSAIDs (careful) pain modulators eg amitriptyline/gabapentin steroids short term (intraarticular)

Question 26

2 main crystal arthropathy conditions?

Answer 26

gout | pseudogout

Question 27

what salt deposition goes on in gout?

Answer 27

monosodium urate crystals

Question 28

is gout more common in women or men

Answer 28

men

Question 29

what can increase purine production and thus increase uric acid?

Answer 29

``` red meats shellfish legumes protein supplements genetics underexcretion rapid cell breakdown eg psoriasis ```

Question 30

what value indicates hyperuricaemia?

Answer 30

>7mg/dL

Question 31

what things would cause underexcretion of uric acid?

Answer 31

``` starvation dehydration hypothyroidism hyperparathyroidism diuretics renal insufficiency ```

Question 32

best time to measure serum urate in a suspected gout patient

Answer 32

2 weeks after acute attack

Question 33

what is the first metacarpal phalangeal joint?

Answer 33

big toe

Question 34

clinical presentation of gout

Answer 34

unilateral hot, red, swollen area that is very painful on either big toe, ankle, knee, upper limb, spine

Question 35

differential diagnoses for gout

Answer 35

septic arthritis trauma psoriatic arthritis

Question 36

what is chronic polyarticular gout?

Answer 36

chronic joint inflammation as a result of recurrent gout attacks over 10+ years

Question 37

investigations for gout

Answer 37

joint aspirate inflammatory markers x ray

Question 38

buzzword for gout findings on joint aspirate

Answer 38

needle shaped crystals | negative birefringence

Question 39

treatment for gout

Answer 39

NSAIDs colchicine corticosteroids analgesia

Question 40

cause of pseudogout?

Answer 40

calcification of cartilage

Question 41

who gets pseudogout?

Answer 41

elderly

Question 42

most common areas affected by pseudogout

Answer 42

knees, wrist, ankles

Question 43

how does allopurinol help in gout

Answer 43

prevents uric acid production

Question 44

risk factors for pseudogout

Answer 44

``` age trauma gout hypercalcaemia hypothyroidism ```

Question 45

treatment for pseudogout?

Answer 45

NSAIDs colchicine steroids rehydration (same as gout)

Question 46

what condition would you suspect if you saw red clumps on the microscope in a 50 year old female complaining of shoulder pain?

Answer 46

hydroxyapatite crystal deposition