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Osteoarthritis and Crystal Arthropathies Flashcards

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1
Q

how common is osteoarthritis (OA)?

A

1/3 of people over 45
1/2 people over 70
8 million people in UK

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2
Q

what does OA do?

A

destruction of articular cartilage

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3
Q

how does OA appear on X ray?

A

decrease in joint space

usually a space is sees as cartilage doesn’t appear, when cartilage lost, bone are tight together

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4
Q

what causes OA?

A

wear and tear in the joints

partly a consequence of ageing but many other risk factors

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5
Q

OA risk factors?

A 
age
female
obesity
previous injury (occupation, sports)
muscle weakness
proprioceptive deficits
genetic elements
acromegaly
joint inflammation
crystal deposition
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6
Q

4 components of cartilage?

A

water
chondrocytes
proteoglycan
collagen filaments

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7
Q

what can cause a solid, bony swelling in OA?

A

formation of osteophytes

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8
Q

what can cause secondary OA?

A

injury
calcium crystal deposition (pseudogout)
RA
etc

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9
Q

what jobs give increased OA risk/earlier presentation?

A

manual jobs (e.g farmers)

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10
Q

what joints does OA affect?

A

weight bearing joints

most commonly used joints (neck, thumb base)

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11
Q

does OA affect MCP joint?

A

generally no

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12
Q

OA vs RA sites?

A

RA can only affect C1 and C2

OA can affect whole spine

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13
Q

describe the clinical presentation of OA?

A

pain worse on activity and relieved by rest - can progress to become painful with little/no activity
morning stiffness lasting less than 30 mins
slow progression (years)

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14
Q

OA examination features?

A

crepitus (friction of bones)
joint swellings (osteophytes)
sometimes tenderness and effusion

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15
Q

clinical hand features of OA?

A

affects DIPs and CMC joint
not MCP
bony enlargements
squaring of hand

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16
Q

what are heberdens nodes?

A

bony enlargements at DIPs

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17
Q

what are bouchard’s nodes?

A

bony enlargements at PIPs

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18
Q

clinical knee features of OA?

A 
osteophytes
effusions
crepitus
restricted movement
Genu varus/vlgus deformities
bakers cyst (in popliteal fossa)
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19
Q

clinical hip features of OA?

A

pain may be felt in groin or radiating to knee

restricted hip movement

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20
Q

clinical spine features of OA?

A 
cervical = pain and restriction of movement
lumbar = pain on walking or standing
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21
Q

what causes spinal symptoms in OA?

A

destruction of IV discs

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22
Q

what is a possible complication of OA in the spine?

A

osteophytes can cause spinal stenosis if they encroach on spinal canal or pinch nerve root

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23
Q

how is OA diagnosed?

A

radiological - loss of joint space, subchondral sclerosis and cysts, osteophytes
clinical - mechanical pain, sites of pain, history etc

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24
Q

how is OA graded?

A

Kellgren-Lawrence
0 = no radiological findings
1 = minute osteophytes
2 = definite osteophytes with unimpaired joint space
3 = definite osteophytes with moderate joint space narrowing
4 = definite osteophytes with sever joint space narrowing and subchondral sclerosis

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25
hands vs knees vs hips progression?
hands - pain often improves over 2 years knees - 1/3 improves, 1/3 stays same, 1/3 gets worse hip - 10% symptoms improve
26
non-pharmacological management of OA?
explanation - keep moving physiotherapy common sense - weight loss etc
27
pharmacological management of OA?
analgesia NSAIDs - mainly gels Pain modulators - anti-convulsants, tricyclics (amitriptyline) Intra-articular - steroids (occasionally hyaluronic acid helps)
28
definitive OA treatment?
surgical joint replacement washout and soft tissue trimming can also help
29
what is gout?
inflammation in the joint triggered by uric acid crystals
30
normal uric acid level?
0.42 mmol/l | above 0.42 it becomes insoluble and precipitates out (hyperuricaemia)
31
common sites of gout?
big toe | fingers
32
what can cause increased uric acid production?
``` enzyme defects increased cell turnover disorders (leukaemia, lymphoma, psoriasis etc) haemolytic disorders alcohol link high purine diet (red meat, seafood) ```
33
causes of reduced urate excretion?
``` chronic renal impairment volume depletion (heart failure) hypothyroidism diuretics cytotoxics (cyclosporin) ```
34
who is gout more common in?
men | doesn't really occur in women before the menopause
35
is gout mono, orli or poly arthropathic?
usually mono (one joint)
36
how does gout arise and resolve?
arises overnight often | settles in 10 days without treatment or 3 days with treatment
37
what does gout look like?
very sudden red swelling over a joint
38
how does uric acid change during an acute attack?
can be normal
39
chronic tophaceous gout?
``` chronic joint inflammation often diuretic associated high serum uric acid tophi involved may get acute attacks ```
40
how is gout investigated?
``` blood test - raised inflammatory markers - serum uric acid raised (or normal if acute) synovial fluid microscopy renal impairment X ray ```
41
how is acute gout treated?
NSAIDs colchicine steroids
42
how is chronic gout treated via prophylaxis?
allopurinol (must be with NSAIDs etc) | Febuxostat
43
when is gout prophylaxis started?
2-4 weeks after acute attack
44
what is deposited in pseudogout?
calcium pyrophosphate
45
what happens in pseudogout?
fibrocartilage in knees, ankles and wrists affected | chondrocalcinosis
46
what are the 2 types of calcium crystal deposition?
``` calcium pyrophosphate (CPP) crystals (pseudogout) calcium hydroxyapatite crystals ```
47
what age group is pseudogout common in?
elderly
48
what do CPP crystals look like?
envelope shaped
49
how is CPP treated?
NSAIDs cochicine steroids rehydration
50
what is hydroxyapatite?
"Milwaukee shoulder" deposition of hydroxyapatite crystals usually in 50-60 y/o females
51
what happens in hydroxyapatite?
release of collagenases, serine proteases and IL1 | acute and rapid deterioration
52
how is hydroxyapatite treated?
NSAIDs intra-articular steroid injection physiotherapy partial or total arhtroplasty
53
what is soft tissue rheumatism?
General term to describe pain caused by inflammation to muscle, tendon, ligament, nerve etc near a joint rather than the joint itself
54
how does pain appear in soft tissue rheumatism?
usually localised to a specific site
55
what is a more generalised soft tissue pain suggestive of?
fibromyalgia
56
what is the most common area for soft tissue pain?
shoulder
57
what can cause soft tissue pain in the shoulder?
``` adhesive capsulitis rotator cuff tendinosis calcific tendonitis impingement partial rotator cuff tears full rotator cuff tears ```
58
where else does soft tissue pain commonly occur?
elbow wrist pelvis foot
59
name some causes for soft tissue pain
carpal tunnel bursitis plantar fascitis
60
how is soft tissue rheumatism treated?
``` pain control rest ice compress PT steroid injections surgery ```
61
how is soft tissue rheumatism investigated?
usually not needed | x ray can show calcific tendonitis
62
how does joint hypermobility syndrome present?
``` arthralgia premature osteoarthritis normal investigations can be general or local more common in females and usually presents in childhood or 3rd decade ```
63
what can cause joint hypermobility?
genetic syndromes - marfans - ehlers danlos syndrome
64
how is joint hypermobility treated?
physiotherapy | explanation to the patient
65
what is modified beighton score?
classification of hypermobility | if >4 of the 9 features = hypermobility
66
what are the features of the modified beighton score?
- >10 degree hyperextension of the elbow - passively touch the forearm with the thumb - passive extension of the fingers or a 90 degree+ extension of the fifth finger - hyperextension of the knees >10 degrees - touching the floor with the palms of the hands without bending the knees

MSK (66 decks)

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