wk 7- joint pain

Question 1

what make up the synovial joint

Answer 1

bone
cartilage covering articular surfaces
synovial fluid
synovial joint capsule

Question 2

what is OA

Answer 2

a chronic, degenerative synovial joint condition which is characterised by loss of articular cartilage and periarticular bone response

more common in women

Question 3

patho of OA

Answer 3

has both mechanical and biological factors to it

mechanical: abnormal loading/wear such as injury, instability, hypermobility, joint dysplasia play a role, deformity, sport, obesity

biological: genetic predisposition, age related changes to cartilage metabolism

1. transmission of inflammatory mediators from synovial fluid into cartilage causing an inflammatory reaction/damage
2. progressive chondrocyte death and cartilage destruction occur
3. subchondral bone undergoes infarction forming bone cysts
4. attempts of repair to stabilse the joint cause subchondral sclerosis and marginal osteophytes
5. inflammation of synovium and periarticular soft tissues

Question 4

what can reduce OA of knee

Answer 4

weight loss

Question 5

features of OA

Answer 5

pain by activity and relieved by rest

rest stiffness developed over time

joint tenderness

swelling

crepitus

restriction ROM

Question 6

radiographic features

Answer 6

• non uniform joint space narrowing
  -osteophytes
  -subchondral sclerosis
  -subchondral cysts
  -loose bodies
  -sublaxation

Question 7

OA management

Answer 7

1. exercise -maintains ROM and strengthens muscles
2. footwear/ assistive devices- cranes, brace, splints, footwear
3. weight loss (esp knee)

pharma
1. NSAIDs non selecitve or cox2 with or without SSRI/SNRI
2. opiods for short term use
3. corticosteroid/hyaluronic acid injections for short term use

1. surgery: joint replacement

Question 8

what is synovial chondromatosis

Answer 8

synovium grows abnormally and produces nodules made of cartilage . nodules can sometimes break off and become loose bodies inside the joint which can damage the smooth articular cartilage

rare condition that can lead to OA

Question 9

what is RA

Answer 9

systemic, inflammatory, autoimmune disease

more common in females

Question 10

RA patho

Answer 10

Triggered by a genetic and environment factor

1. synovial plasma cells produce antibodies that form immune complexes and stimulate leucocyte proliferation
2. T cells infiltrate the synovium and secrete cytokines which recruits more inflammatory cells like macrophages into the joint which secrete more cytokines
3. This stimulates pannus formation of the synovial membrane which causes destruction of cartilage, bone and soft tissue

Question 11

what causes RA to occur

Answer 11

cause is unknown but there are

1. genetic (50% of risk)
2. environmental risk factors
   - smoking
   -infections
   -diet
   -air pollution
   -silica exposure
   -alcohol
   -obesity

Question 12

clinical featyres of RA

Answer 12

symmetrical
presents insidiously
multiple joints
joint swelling
warmth
redness
stiffness after inacitvity
pain
systemic symptoms

Question 13

complications of foot for RA

Answer 13

Common deformities: pes planus, plantar fasciopathy, tib post/achilles tendonitis , hallux valgus, hammer toes

rheumatoid nodules at sites of pressure in 30% of patients

Question 14

complications of RA extra articular

Answer 14

• vascular complications
  -neuropathy in half the cases
  -nodules
  -ulcers
  -infection
  -eye complications
  -anaemia/iron deficiency

Question 15

how do you detect an active disease in RA

Answer 15

1. lateral squeeze test
2. swollen joint count
3. exam and palpation of tendons and bursae

Question 16

early referral for RA criteria

Answer 16

1. 3+ swollen joints
2. squeeze test positive for MTP and or MCP
3. morning stiffness 30mins or more

Question 17

RA management

Answer 17

1. referral to rheumatologist - early diagnosis improves outcomes

pharma: conventional synthetic disease modifying anti rheumatic drugs

1. methotrexate oral or subcutaneous injection once weekly
   2.Leflunomide, sulfasalzine and hydroxychloroquine may be used alone or in combination
2. corticosteroids are used to manage symptoms until antirheumatic drugs begin
3. • biological disease modifying anti rheumatic drugs (infliximab)
     - increased risk of infections
4. immunisations

Question 18

gout what is it

Answer 18

inflammatory arthritis associated with hyperuricaemia and uric acid crystals

common in men at the 1MTPJ

Question 19

risk factors for gout

Answer 19

• alcohol
  -diet of purines (red meat, seafood)
  -aspirin, diuretics, cytotoxic drugs (that raise plasma urate levels)
  -fam history
  -conditions

Question 20

gout patho

Answer 20

hyperuricaemia occurs through
1. decreased renal urate excretion- alcohol
2. increased urate production
3. or increased intake - purine rich foods

monosodium urate crystals may occur in response to an event

Question 21

diagnosis of gout

Answer 21

• serum urate (not reliable because levels may be dropping after attack)
  -US imaging

Question 21

features of gout

Answer 21

• 1st mTPJ
  -Swollen, hot, red joint
  -tender
  -tophi (chronic)
  -unable to weightbare
  -loss of ROM

Question 21

management for gout

Answer 21

1. rule out septic arthritis
2. NSAIDs/prednisone/local corticosteroid injection
3. urate lowering medication if 2+ attacks within a year
4. bloods checked every 4-6 weeks after attack

Question 22

pseudogout what is it

Answer 22

build up of calcium pyrophosphate crystals in joints

Question 23

what is septic arthritis

Answer 23

bacterial invasion of the synovial space, common in 1st MTPJ

diabetics, RA, prosthetics, joint surgery at a higher risk

fatal

Question 24

diagnose septic arthritis

Answer 24

arthrocentesis and synovial culture

Question 25

symptoms of septic arthritis

Answer 25

red hot swollen joint
fever
pain