Osteoarthritis and spondylarhtorpathies Flashcards Preview

PM3B: Autumn > Osteoarthritis and spondylarhtorpathies > Flashcards

Flashcards in Osteoarthritis and spondylarhtorpathies Deck (23):
1

What is osteoarthritis

Disease of synovial joints where articular cartilage loss leads to accompanying periarticular bone response

Bones rubbing together affects muscle

2

Describe the four stages of disease progression that occur in osteoarthritis

1. Initial Repair
Proliferation of chondrocytes that synthesise extracellular matrix of bone

2. Early Stage Osteoarthritis
Degradation of extracellular matrix that exceeds chondrocyte activity resulting in net breakdown and loss of articular cartilage at joint

3. Immediate Stage Osteoarthritis
Failure of extracellular matrix synthesis and increased break down of cartilage

4. Late stage osteoarthritis
Extreme or complete loss of cartilage with joint space narrowing
Bony Outgrowths appear at joint margins
General bone sclerosis
Pain and reduced joint movement

3

What are the risk factors of osteoarthritis

Increasing age

Gender
Less than 45 = men
55-70= women
Knee osteoarthritis= women

Race
Hip osteoarthritis less common in chinese, afro-carribean compared to europeans

Obesity- BIG FACTOR

Physical and occupational factors

Trauma

4

What are the symptoms of osteoarthritis

Joint pain in weight bearing joints (hip, knee, spine)

Pain- worse with movement

Morning stiffness joint, lasts for less than 30 minutes

Synovial thickening

Deformity of joint

Bone swellings

Limited Joint Movement

Joint effusion

Muscle weakening or wasting

Crepitus- cracking or popping of joint

5

How do you diagnose osteoarthritis

Clinical presentation
(location of affected joint, pain on movement not at rest, gets worse throughout day)

X ray:
Narrowing of joint space
Bony protrusions
Bony sclerosis

Arthroscopy
Yellowing
Irregular
Ulcerated- cartilage often present

6

What are the treatment goals for osteoarthritis

Reduction of pain due to damage to bone and cartilage

Increased mobility

Reduced disability

Minimal disease progression

7

what are the non drug treatment options of osteoarthritis (4)

Exercise- builds up muscle strength and improve range of joint movement

Weight loss- helps protect against weight bearing joints

Physical therapy- heat, cold, ultrasound, TENS machine

Education- chronic but not progressive
Alleviate psychological factors

8

What available complementary therapies are there for osteoarthritis

Nutraceuticals- glucosamine and chondroitin

Acupuncture

Magnets and copper braces

9

What are the treatment options available for management of osteoarthritis

Paracetamol (FIRST CHOICE)

Topical NSAIDS

Intra-articular corticosteroid Injections- benefit of reduced pain and increased mobility from soft tissue inflammation

Intra-articular injection of hyaluronic acid derivatives- into synovial fluid and returns its elasticity and viscosity

Rubefacients- counter irritants

Surgery- if physical and drug treatment fail

10

What are rubefacients able to cause and give an example of them

Redness
Dilation of capillaries
Increase of blood flow to area

Example:
Capsaicin (0.025%) for symptomatic relief

11

Spondylarthropathies a general term for inflammatory rheumatic diseases such as...

Ankylosing Spondylitis

Psoriatic or reactive arthritis

Enteropathic Arthritis- associated with inflammatory bowel disease

12

What is ankylosing spondylitis

Condition that causes inflammation of sacroiliac joint that makes up the spine leading to symptoms

13

What are the symptoms present in ankylosing spondylitis

Morning back stiffness and pain for more than 30 minutes

Pain- better with exercise not rest

14

What can ankylosing spondylitis lead to

Spinal fusion (ankylosis)

Decrease in spinal movement
Leads to spinal kyphosis
Sacroiliac joint fusion
Neck hyperextension and rotation

15

How do you diagnose ankylosing spondylitis

X ray

Has to have criterion of Sarcoilitis

Or Clinical Criterion:
Low back pain and stiffness- improves with exercise for 3 months

Limitation of motion of lumbar spine in sagitall and frontal plans

Limitation of chest expansion for age and sex

Excludes: spinal fracture, disc disease, fibromyalgia

16

What is the activity index that is used to assessing ankylosing spondylitis called and consist of

BATH AS disease index (BASDAI)

Questions like:
Fatigue

Spinal Pain

Joint pain and swelling

Areas of localised tenderness

Morning Stiffness

Scored between 0-10
1-3 mild, 4-7 moderate, 8-10 severe

17

How do you treat ankylosing spondylitis non drug treatments and drug treatments

Exercise TWICE daily (maintain posture and mobility)

Drugs:
Slow release of NSAIDS taken at NIGHT
Relieves NIGHT pain, MORNING stiffness and REST pain
Ibuprofen modified release, diclofenanc sodium modified release

Methotrexate or sulfasalazine can help peripheral arthritis

Cytokine modulators (biologics) used when they have active disease and 2 NSAIDs have failed:

Adalimumab and Infliximab- antibody binds to TNF-alpha to block interaction with receptor

Etanercept- TNF alpha receptor fusion protein that inhibits TNF alpha

18

What is psoriatic arthritis

Asymmetrical arthritis in small joints of hand

Rheumatoid like symmetrical seronegative polyarthritis

Arthritis mutilans: severe form that destroys small bones in hands or feet

19

How do you treat psoriatic arthritis

Analgesia and NSAIDs

DMARDS:
Methotrexate and azathioprine (unlicensed)

Sulfasalazine and Leflunomide (licensed) and ciclosporin

Cytokine modulators

Lefluomide

20

What is reactive arthritis

Arthritis tha occurs following an infection

Such as GI infection (shigella, salmonella, campylobacter

STI: chlamydia

21

What is the pathology of reactive arthritis

Persistant bacterial antigens in inflamed but sterile synovium of affected joints that drive inflammation reaction

22

How do you treat reactive arthritis

Antibiotics

Acute inflammation:
NSAIDS
Local joint aspiration
Corticosteroid injections

23

What is Enteropathic arthritis

Linked to inflammatory bowel disease or ulcerative colitis or crohn's disease