What is the most common type of arthritis?
What is osteoarthritis?
Progressive, degenerative joint inflammation due to loss of cartilage
In osteoarthritis, much of the joint space is ___.
What forms at the edges of bone in osteoarthritis?
Bony spurs (osteophytes)
Which protein makes up most of cartilage?
Type 2 collagen
What cells form the matrix of cartilage?
In osteoarthritis, the matrix of cartilage is ___.
Why do osteophytes form in osteoarthritis?
Attemped bone repair (sclerosis as well)
Osteoarthritis tends to have a(n) (acute / gradual) onset.
What type of pain do people with osteoarthritis get?
i.e worse on activity, relieved by rest
When is mechanical pain of osteoarthritis at its worst?
End of the day
What name is given to grinding/creaking of joints on movement?
How long does stiffness tend to last in osteoarthritis?
< 30 minutes
Osteoarthritis (does / doesn't) affect the DIP joints.
At which joints do:
a) Heberden's nodes
b) Bouchard's nodes
form during osteoarthritis?
a) DIP joint
b) PIP joint
Bony enlargements seen in osteoarthritis are (soft / hard).
Just as in RA, osteoarthritis may cause ___ of the thumbs.
What is a Baker's cyst?
Swelling in the popliteal fossa
Where is hip pain felt?
"Hip pain" described by patients may actually be caused by osteoarthritis of ___ joints.
When does osteoarthritis tend to start?
Osteoarthritis is more common in (men / women).
Occupations involving a lot of heavy ___ accelerate the onset of OA.
What are some underlying conditions which can accelerate the onset of OA?
What type of arthritis must be excluded when taking a history from patients?
The inflammatory markers of OA patients are usually ___.
What are some X-ray features of OA?
Loss of joint space
What are the primary hand joints affected in OA versus RA?
OA - DIPs
RA - PIPs, MCPs
How do joints feel in OA versus RA?
OA - hard, bony
RA - soft, hot and tender
When is stiffness at its worst in OA versus RA?
At the end of the day as opposed to in the mornings
What sort of exercise are OA patients encouraged to do?
Low impact exercise (e.g pilates, swimming) so weight is loss but joints aren't damaged further
What non-pharmacological therapies may OA patients require?
Occupational therapy - footwear, mobility aids
What drugs can OA patients be prescribed?
Analgesics e.g paracetamol
NSAIDs but be careful
Opiates, pain modulars e.g amitryptyline, IA steroids for short term relief
If OA has progressed to a point where it causes constant pain or reduced mobility, patients may be referred for ___.
What are the most common joint replacements carried out by the NHS?
(Uncommonly shoulder, elbow, fingers)
What are the two main crystal arthropathies?
Which crystals cause them?
Gout (uric acid)
Pseudogout (calcium pyrophosphate)
What is gout?
Inflammatory arthritis caused by uric acid crystals deposited in joints
Gout is more common in (men / women).
What is the metabolic product responsible for gout?
Apart from being a metabolite of food, purines are also produced when cells are __ __.
What is the biochemical pathway producing uric acid?
How is uric acid excreted?
What is hyperuricaemia?
Serum uric acid > 7 mg/dL
Why can people with psoriasis develop gout?
High cell turnover
Does everyone who is hyperuricaemic develop gout?
No, don't blindly treat without symptoms
What change re: uric acid actually causes gout?
Acute changes in uric acid level
What is the main presentation of gout?
Rapid onset of severe pain in joint
Bright-red, hot, lasts up to 2 weeks
What are the most common sites for gout?
can affect upper limb and spine too
Which medications can cause gout?
What must be excluded in someone with a hot, swollen joint?
What are depositions of uric acid in the skin called?
In gout, inflammatory markers will be (raised / reduced).
WCC may be raised in gout - what must be excluded at this stage?
osteomyelitis, cellulitis, septic arthritis...
X-rays appear normal in acute attacks of gout. How may they appear after chronic attacks?
What is the gold standard investigation for gout?
How is an acute attack of gout managed?
NSAIDs for pain
(If contraindicated, colchicine)
(If both contraindicated, steroids)
And loads more analgesia (paracetamol, opiates)
What is an inconvenient side effect of colchicine?
What are some lifestyle recommendations for gout patients?
Reduce protien intake - red meat, beans, shellfish
Reduce alcohol intake
Drink plenty of fluids (but not fizzy drinks)
What drugs are used as prophylaxis for gout?
Which enzyme do they inhibit?
Allopurinol or Febuxostat
Allopurinol is started 2-4 weeks after acute gout in a low dose - why?
Sudden changes in uric acid level will cause another episode of gout
Pseudogout is more common in (young / old) people.
Which crystal is deposited?
What shape are the crystals seen in:
Gout - needle shaped crystals
Pseudogout - rhomboids
Can patients have both gout and pseudogout?
Is allopurinol used in pseudogout?
No - xanthines not involved
How is pseudogout treated?
NSAIDs / colchicine / steroids