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MSK Flashcards

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1
Q

Define osteoarthritis

A
  • Cartilage destruction and loss with accompanying periarticular and articular inflammation and alteration of bone and cartilage structure
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2
Q

What is the epidemiology of non-inflammatory degenerative (NID) arthritis (4)

A
  • Usually seen in older people
  • more common in women
  • Most common type of arthritis
  • Mostly affects articular cartilage
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3
Q

What are the risk factors for NID arthritis (6)

A
  • Obesity
  • Inc. age
  • Female
  • Occupation (eg. manual labour)
  • Trauma
  • Diabetes
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4
Q

Describe the pathophysiology of NID arthritis

A
  • Progressive loss and destruction of articular cartilage leads to imbalance of articular cartilage destruction/production
  • This leads to the new cartilage produced being fissured
  • This causes the articular bones to undergo increased stress and leads to their damage
  • This causes the formation of jagged abnormal sclerotic bone (osteophytes)
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5
Q

How might NID arthritis present (6)

A
  • Gradual onset, progressive joint pain
  • Worse on exercise
  • Morning stiffness <30 mins
  • Heberdens/bouchards nodes
  • Muscle wasting around joints
  • Limited movement of joints
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6
Q

How do you diagnose NID arthritis (3)

A
  • X-ray (LOSS)
  • MRI
  • Joint aspiration (if possible)
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7
Q

How do you treat NID arthritis (5)

A
  • Paracetamol/ibuprofen/weak opioid
  • Ice/heat pack
  • Physio./exercise/weight loss
  • Surgery
  • Joint steroid injections
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8
Q

What is rheumatoid arthritis

A
  • A chronic inflammatory autoimmune disorder causing symmetrical polyarthritis
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9
Q

What is the epidemiology of rheumatoid arthritis (3)

A
  • More common in women
  • More common 30-50 less common in elderly than OA
  • Associated with smoking
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10
Q

What are the risk factors for rheumatoid arthritis (3)

A
  • Smoking
  • Female
  • Family history/genetic
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11
Q

Describe the pathophysiology of rheumatoid arthritis

A
  • Overproduction of TNF alpha in synovial joints
  • Causes inflammation (synovitis) and joint destruction
  • Synovium proliferates and forms a pannus
  • The pannus then destroys the joint cartilage leading to bone exposure, erosion and damage
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12
Q

How might rheumatoid arthritis present (5)

A
  • Progressive, symmetrical joint pain and inflammation
  • Joints are hot and tender
  • Morning stiffness >30 mins
  • Relived by exercise
  • Muscle wasting and hand deformities
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13
Q

How do you diagnose rheumatoid arthritis (3)

A
  • Bloods (raised CRP/ESR, anaemia RF positive)
  • X-ray/MRI (bone erosion)
  • Joint aspiration (high white cells)
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14
Q

How do you treat rheumatoid arthritis (5)

A
  • Weight loss/exercise/smoking cessation
  • Paracetamol/NSAID/codeine
  • Oral prednisolone
  • Disease modifying anti-rheumatic drugs (DMARDs)
    • Methotrexate (inhibit inflammatory cytokines)
  • TNF alpha blockers
    • Infliximab
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15
Q

What is osteoporosis (2)

A
  • Systemic skeletal disease with low bone mass and micro-architectural deterioration of bone leading to increased susceptibility to fracture
  • Bone mineral density >2.5 s.d from the mean young adult value on a DEXA scan
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16
Q

What is the epidemiology of osteoporosis (3)

A
  • Increases with age
  • More common in females
  • More common in caucasians and asians
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17
Q

What are the risk factors for osteoporosis (4)

A
  • Female
  • Increasing age
  • Caucasian/asian
  • SHATTERED
  • Steroid
  • Hyperthyroid/parathyroidism (PH/PTH inc. bone resorption)
  • Alcohol/tobacco
  • Thin
  • Testosterone low
  • Erosive/inflammatory bone disorder
  • Renal/liver failure
  • Early menopause (low oestrogen)
  • Diet (dec. calcium)
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18
Q

How might osteoporosis present

A
  • Fracture (wrist, femur, vertebrae)
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19
Q

How do you diagnose osteoporosis

A
  • Dual energy X-ray absorpimetry (DEXA)
    • > 2.5 sd from mean = osteoporosis
    • 1.5-2.5 sd from mean = osteopenia
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20
Q

How do you treat osteoporosis (3)

A
  • Smoking cessation/exercise/calcium in diet
  • Biphosphonates (decrease bone resorption)
    - Aldendronate
  • HRT (oestrogen/testosterone)
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21
Q

What is systemic lupus erythromatosus (SLE)

A
  • An inflammatory systemic autoimmune disorder characterised by rash and arthralgia as most common and renal/cerebral as most serious symptoms
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22
Q

What is the epidemiology of SLE (3)

A
  • More common in women
  • Onset typically 20-40
  • Most common in Afro-Caribbeans and Asians
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23
Q

What are the risk factors for SLE (4)

A
  • Family history/genetics
  • EBV
  • Female
  • Afro-Caribbean/Asian
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24
Q

Describe the pathophysiology of SLE

A
  • Cellular remnants that are usually hidden from immune system during apoptosis are inefficiently destroyed
  • Hence they get into the lymphoid system and antibodies are produced against them
  • This causes inflammatory autoimmune attack with neutrophillic invasion and abnormal cytokine production
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25
How might SLE present (6)
- Fever and malaise/arthralgia - Skin (85%) - Butterfly erythema - Photosensitive rash - Joint (90%) - Symptoms similar to RA - Mouth ulcers very common - Renal (30%) - Glomerulonephritis - CNS (60%) - Seizure - Psychosis
26
How do you diagnose SLE
- Bloods - Raised ESR but not CRP - Anaemia - Serum anti nuclear antibodies (ANA) positive
27
How do you treat SLE (5)
- Acute attack - High does prednisolone and iv cyclophosphamide - Prednisolone - Immunosupression (Azathioprine) - NSAIDs for arthritis/fever - Reduce CVS risk (B.P and statins)
28
What is antiphospholipid syndrome
- A syndrome characterised by thrombosis and/or recurrent miscarriage with positive serum antiphospholipid antibodies
29
What is the epidemiology of antiphospholipid syndrome (2)
- Associated with SLE | - More common in females
30
Describe the pathophysiology of antiphospholipid syndrome
- Antiphospholipids bind to phospholipid on the surface of platelets causing thrombus formation
31
How might antiphospholipid syndrome present (3)
- Thrombosis (PE, stroke, DVT, MI) - Miscarriage - Thrombocytopenia (bleeding, bruising, purpura)
32
How do you diagnose antiphospholipid syndrome
- Anticardiolipin test - Tests for antibodies that bind to phospholipid - At least 2 positive tests 12 weeks apart
33
How do you treat antiphospholipid syndrome (3)
- Warfarin - Aspirin - LMW heparin (clopidogrel)
34
What is Sjorgens syndrome
- Chronic autoimmune destruction of epithelial exocrine glands especially the lacrimal and salivary glands
35
Describe the pathophysiology of Sjorgens
- Lymphocytic infiltration, inflammation and hence fibrosis of exocrin glands, especially lacrimal and salivary
36
How might Sjorgens present (4)
- Dry eyes - Dry mouth - Dry vagina - Dry skin
37
How do you diagnose Sjorgens
- Schirmer tear test | - Filter paper on eyelid, <5mm tears = Sjorgens
38
What is the treatment for Sjorgens
- Artificial tears and Saliva replacement therapy
39
What is the epidemiology of systemic sclerosis (scleroderma) (2)
- More common in females | - Usually presents 30-50
40
Describe the pathophysiology of systemic sclerosis
- Vascular endothelial damage leads to vasoconstriction - Continuous vascular damage leads to uncontrolled and irreversible proliferation of fibroblasts and other connective tissue - This leads to vascular wall thickening and fibrosis hence lumen narrowing - This causes widespread ischaemia
41
How might limited cutaneous scleroderma present (5)
- CREST - Calcium deposits - Raynauds - Eosphageal stricture/dysmotility - Sclerodatyly (tight skin/ulcers on digits) - Telenagiectasia (spider veins)
42
How might diffuse cutaneous scleroderma present (5)
- Raynauds - GI (oesophageal, SI, LI dysmotility) - Renal (AKI/CKD) - Pulmonary fibrosis/hypertension (pulmonary vessel fibrosis) - Myocardial fibrosis (arrythmia)
43
How do you diagnose systemic sclerosis (3)
- Positive anti nuclear antibodies - Limited - positive anti centromere antibodies - Diffuse - positive anti RNA polymerase antibodies
44
How do you treat systemic sclerosis (4)
- Raynauds - Hand warmers - CCB (vasodilators) (verapamil) - PPI (lansoprazole) for GI - Renal (B.P control) - Pulmonary fibrosis (prednisolone/azathioprine)
45
What is polymyositis/dermatomyositis
- Inflammation and necrosis of skeletal muscle fibres of unknown aetiology, skin involvement is dermatomyositis
46
How might Polymyositis/dermatomysositis present (4)
- Progressive shoulder/pelvic muscle weakness - May also affect respiratory and swallowing muscles - Raynauds (demato) - Purple discolouration of eyelids and knuckle plaques
47
How do you diagnose Polymyositis/dermatomysositis
- Muscle biopsy | - Shows necrosis/inflammation of muscle fibres
48
How do you treat Polymyositis/dermatomysositis (2)
- Oral prednisolone | - Azathioprine
49
What do seronegative spondyloarthropathies have in common (4)
- Axial inflammation - Peripheral arthritis - Rheumatoid factor negative (seronegative) - HLA-B27 association
50
What is HLA-B27 (4)
- Human leucocytic antigen B27 - Surface antigen present in all cells - Plays a role in immunity - You are either HLA-B27 positive or negative
51
What might indicate you to think seronegative spondyloarthropathy
- SPINEACHE - Sausage digits - Psoriasis - Inflammatory back pain - NSAID response - Enthesitis - Arthritis - CRP raised - HLA-B27 - Eye (uveitis)
52
What is ankylosing spondylitis
- A chronic inflammatory disorder of the spine, ribs and sacro-iliac joints - Ankylosing means stiffness due to new bone formation
53
What is the epidemiology of ankylosing spondylitis (3)
- More common in males - Usually presents <30 - 88% HLA-B27 positive
54
Describe the pathophysiology of ankylosing spondylitis
- Lymphocytic infiltration and erosion of ligament insertions at rib, spine and sacro-iliac joints - Leads to new bone formation which causes pain and stiffness and eventually bamboo spine
55
How might ankylosing spondylitis present (5)
- Gradual onset back pain/stiffness - Episodic sacro-iliac inflammation - Peripheral arthritis - Worse in morning/at night - releived by exercise
56
How do you diagnose ankylosing spondylitis (2)
- Bloods - Raised ESR/CRP - HLA-B27 positive - X-ray - Joint erosion/new bone formation
57
How do you treat ankylosing spondylitis (5)
- Exercise/posture for back - NSAIDs for pain - DMARDs (methotrexate) for peripheral arthritis - TNF alpha blockers (infliximab) - Joint steroid injections
58
How psoriatic arthritis present (3)
- May be symmetrical or asymmetrical - Most commonly only affects DIPJs - Skin psoriasis
59
How do you diagnose psoriatic arthritis
- X-ray | - Central joint bone erosion
60
How do you treat psoriatic arthritis (4)
- NSAIDs - Joint steroid injection - DMARDs (methotrexate) - TNF alpha blockers (infliximab)
61
What is reactive arthritis
- Sterile inflammation of joint in response to distal infection
62
What is the epidemiology of reactive arthritis (3)
- HLA-B27 increases risk 30x - More common in males - Usually caused by GI/STI
63
How might reactive arthritis present (3)
- Acute asymmetrical lower limb arthritis - Days to weeks post infection - Cant see, cant wee, cant climb tree - Uveitis - Penis ulcers - Enthesitis
64
How do you diagnose reactive arthritis (2)
- ESR/CRP raised - Joint aspiration - Sterile with high neutrophils
65
How do you treat reactive arthritis (3)
- NSAIDs - Treat infection - Methotrexate/infliximab if persistent
66
What is systemic vasculitis
- Inflammation and necrosis of blood vessels leading to aneurysm/rupture and thrombosis/ischaemia/infarct
67
What conditions are associated with vasculitis (6)
- Infective endocarditis - SLE - Systemic sclerosis - Polymyositis/dermatomyositis - Rheumatoid arthritis - IBD
68
What is the epidemiology of polymyalgia rheumatica (3)
- Type of vasculitis - More common in females - Only in over 50s
69
How might polymyalgia rheumatica present (4)
- Sudden onset severe pain and stiffness in neck, shoulders, back and hips - Worse in mornings - Peripheral arthritis - May have fever/malaise
70
How do you diagnose polymyalgia rheumatica (2)
- ESR and CRP raised | - History and over 50
71
How do you treat polymyalgia rheumatica
- Oral prednisolone | - PPI, biphosphonates, calcium (long term steroids)
72
What is giant cell arteritis
- Granulatomous inflammation of the large cerebral arteries in association with polymyalgia rheumatica
73
How might giant cell arteritis present (5)
- Severe headache - Scalp tenderness - Jaw claudication - Sudden painless vision loss - Polymyalgia rheumatica
74
How do you diagnose giant cell arteritis
- Temporal artery biopsy
75
What is the treatment for giant cell arteritis
- High dose prednisolone, taper down
76
What is the epidemiology of gout (3)
- More common in males - Increases with age - Most common inflammatory arthritis in the UK
77
What are the risk factors for gout (6)
- Obesity - Diabetes - Renal disease - Diet (high purine food/high sugar) - Family history - IHD
78
Describe the pathophysiology of gout
- Purine (red meat/seafood, but mostly energy pproduction) is broken down into uric acid - If the amount produced exceeds amount excreted by kidneys leads to hyperuricamia - This leads to monosodium urate crystal formation in the joints causing pain and inflammation
79
How might gout present (2)
- Acute - Sudden onset pain, swelling and redness usually of big toe (MTP) - May be polyarthritic - Tophaceous - Formation of tophi (aggregates of m.s urate and inflammatory cells) - Lead to bone erosion, pain and stiffness
80
How do you diagnose gout (2)
- Joint aspiration - Long needle like crystals, negative to polarised light - Hyperuricaemia
81
How do you treat gout (4)
- Dietary change (inc. dairy, dec. red meat/seafood) - Weight loss - Acute - NSAIDs - Prednisolone - Prevention - Allopurinol (dec. uric acid production)
82
What are the risk factors for pseudogout (4)
- Mostly affects old women !!!!!!!!!! - Diabetes - Osteoarthritis - Trauma
83
How can pseudogout present (3)
- Acute severe pain and swelling in knees/wrists - Red, warm swelling - Fever
84
How do you diagnose pseudogout
- Joint aspiration - Sodium pyrophosphate crystals - Small rhomboid and positive to polarised light
85
How do you treat pseudogout (3)
- NSAIDs - Prednisolone - Joint aspiration
86
What is fibromyalgia
- Widespread musculoskeletal pain for more than 3 months, with pain on 11/18 tender sites on palpitation and all other causes excluded
87
What is the epidemiology of fibromyalgia (3)
- More common in females - Usually seen in older people - Association with rheumatoid arthritis
88
What are the risk factors for fibromyalgia (4)
- Female - Chronic disease - Inc. age - Poor socio-economic status
89
How might fibroyalgia present (6)
- Widespread chronic pain - Usually centres around back and neck - Morning stiffness - Feet and hand paraesthesiae - Aggravated by exercise, cold and stress - Usually extreme fatigue and sleep problems
90
How do you diagnose fibromyalgia (2)
- 11/18 tender sites on digital palpitation, >3 months | - All other causes excluded
91
How do you treat fibromyalgia (4)
- Educate patients and family - Treat sleep problems - Try to increase their fitness - Low dose antidepressants/anticonvulsants
92
What are the red flags for back pain (6)
- Progressive - Neurology - Violent trauma - >20, <55 - Systemic unwell/weight loss - Drugs
93
What is the epidemiology of mechanical back pain (3)
- Usually 20-55 - Associated with manual labour - Smoking and stress association
94
What are the causes of mechanical back pain (3)
- Disc prolapse - Osteoarthritis - Heavy manual handling
95
How might mechanical back pain present (5)
- Stiff painful back +/- scoliosis - Sudden onset - Relieved by rest, exacerbated by exercise - Worse in evening, better in morning - Palpable spasm
96
How do you treat mechanical back pain (2)
- Physiotherapy | - NSAIDs, paracetamol, codeine
97
What is the epidemiology of septic arthritis (2)
- Increases with age | - Most common cause is staph areus
98
What are the risk factors for septic arthritis (6)
- Immunosuppresion - Rheumatoid arthritis - Trauma - Joint surgery - Prosthetic joint - Diabetes
99
How might septic arthritis present (3)
- Acute severe pain, swelling and redness of joint - Fever - Usually mono, can be polyarthritis
100
How do you diagnose septic arthritis
- Joint aspiration + culture
101
How do you treat septic arthritis (5)
- If on steroids then double the dose - Immobilisation - Antibiotics - NSAIDs for pain - Joint aspiration
102
What is the epidemiology of osteomyelitis (3)
- Most common in children - In children usually secondary to direct trauma - in elderly usually due to risk factors
103
What are the risk factors for osteomyelitis (5)
- Immunosuppression - Trauma - Diabetes - Prosthetic implant - RA
104
How might osteomyelitis present (3)
- Dull ache in bone affected, may be aggravated by movement - Warm, tender erythema - Fever, sweats, rigors
105
How do you diagnose osteomyelitis
- Bone biopsy + culture
106
How do you treat osteomyelitis (3)
- Antibiotics - Immobilisation - Surgery to remove dead bone
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