T2 L13 Intro to diseases of MSK system Flashcards

Question

How much is spent in the UK on treating MSK conditions?

Answer 1

£10 billion

Answer 2

Septic arthritis

Answer 3

11% | Increases to 50% in polyarticular disease with sepsis

Answer 4

Staph | Strep

Answer 5

Monosodium urate crystals form and deposit in cartilage, bone and periarticular tissue of peripheral joints Serum rate levels above physiological saturation point (408umol/L)

Answer 6

Negative birefringent rods of monosodium urate | Pseudogout by positively birefringent rods of calcium pyrophosphate

Answer 7

Men ≥40 Women ≥65 1 in 40 adults

Answer 8

``` Male sex Older age Metabolic syndrome - obesity, hypertension, hyperlipidaemia Loop and thiazide diuretics Genetic factors Osteoarthritis Chronic kidney disease Dietary factors ```

Answer 9

NSAIDs e.g. naproxen Colchicine Steroids

Answer 10

Urate-lowering therapy e.g. allopurinol or febuxostat

Answer 11

Chronic multisystem inflammatory condition

Answer 12

Affects 0.5-1% of worlds population | More common in women

Answer 13

45-65 years

Answer 14

1) Early lymphocyte invasion of synovium 2) Acute inflammatory response - swelling and increased vascular permeability 3) Synovial proliferation 4) Pannus formation 5) Cartilage destruction and bone erosion

Answer 15

Symmetrical pain and boggy swelling of small joints of hands and feet (MCP, PIP, Wrist, MTP, Subtalar) Not DIP

Answer 16

``` Nodules Bursitis / tendosynovitis Dry eyes Splenomegaly Anaemia of chronic disease Lung fibrosis Pericarditis Leg ulcers Neurological Renal amyloidosis Vasculitis Increased risk CVD ```

Answer 17

``` ESR, CRP FBC, Rheumatoid factor positive Anti-CCP antibodies X-rays ```

Answer 18

Normal in early disease Erosions / peri-articular osteoporosis Reduced joint space / cysts

Answer 19

``` Early and aggressive treatment to reduce inflammation and joint damage NSAIDs Corticosteroids DMARDs Biologic agents MDT input ```

Answer 20

Methotrexate Sulfasalazine Hydroxychloroquine Leflunomide

Answer 21

``` Anti-TNF agents (etanercept, adalimumab) Anti-B cell (rituximab) Anti-IL6- receptor blocker (tocilizumab) Anti-T cell selective co-stimulation modulator (abatacept) JAK2 inhibitor (tofacitinib) ```

Answer 22

Degenerative disease characterised by joint pain and variable degrees of functional limitation

Answer 23

Distal interphalangeal Proximal interphalangeal 1st carpometacarpal joint

Answer 24

1) Metabolically active dynamic process involving all joint tissues (cartilage, bone, synovial, capsule, ligaments / muscles) 2) Focal destruction of articular cartilage 3) Remodelling of adjacent bone - hypertrophic reaction at joint margins) 4) Remodelling and repair process 5) Secondary synovial inflammation and crystal deposition

Answer 25

Morning stiffness lasting less than 30min Persistent joint pain that is aggravated on use Crepitus No inflammation Bony enlargement and/or tenderness

Answer 26

Chronic, relapsing remitting disease | Broad spectrum clinical features involving almost all organs and tissues

Answer 27

97 per 10,000 in UK Female: male is 10-20:1 Peak onset is 15-40 years More common in Afro-Caribbean, India, Hispanic and Chinese

Answer 28

1) Genes and environment 2) Abnormal immune response 3) Autoantibodies immune complex 4) Inflammation - rash, nephritis, arthritis, leukopenia, CNS disorder, clotting 5) Damage - renal failure, atherosclerosis, pulmonary fibrosis, stroke

Answer 29

``` C1q, C2, C4 HLA-D2,3,8 MBL FcR 2A, 3A, 2B IL-10 MCP-1 PTPN22 ```

Answer 30

``` Skin - malar rash, discoid rash CNS - neurological damage, affective disorder Lung - inflammation Spleen - splenomegaly Joints - arthritis Kidney - glomerulonephritis Serum - antinuclear antibodies Blood - IFN signature, anaemia, thrombocytopenia ```

Answer 31

``` Urinalysis FBC Urea and electrolytes ESR CRP Liver function test Antibodies - ANA, ENA, anti-dsDNA, lupus anticoagulant C3, C4 ```

Answer 32

Sun protecting Smoking cessation CVD risk modification Osteoporosis prevention

Answer 33

``` Synovial disease Affects MCPs & PIPs instead of DIPs and 1st CMCJ Stiffness in morning for more than 30min Less stiff after activity Raised inflammatory markers Extra-articular features Autoimmune ```

Answer 34

Both are bilateral and symmetrical | Both have family history

Answer 35

On exertion and at end of day