3: Osteoarthritis and crystal arthropathies Flashcards Preview

MSK Week 2 2017/18 > 3: Osteoarthritis and crystal arthropathies > Flashcards

Flashcards in 3: Osteoarthritis and crystal arthropathies Deck (64)
1

What is the most common type of arthritis?

Osteoarthritis

2

What is osteoarthritis?

Progressive, degenerative joint inflammation due to loss of cartilage

3

In osteoarthritis, much of the joint space is ___.

lost

4

What forms at the edges of bone in osteoarthritis?

Bony spurs (osteophytes)

5

Which protein makes up most of cartilage?

Type 2 collagen

6

What cells form the matrix of cartilage?

Chondrocytes

7

In osteoarthritis, the matrix of cartilage is ___.

lost

8

Why do osteophytes form in osteoarthritis?

Attemped bone repair (sclerosis as well)

9

Osteoarthritis tends to have a(n) (acute / gradual) onset.

gradual

10

What type of pain do people with osteoarthritis get?

Mechanical pain

i.e worse on activity, relieved by rest

11

When is mechanical pain of osteoarthritis at its worst?

End of the day

12

What name is given to grinding/creaking of joints on movement?

Crepitus

13

How long does stiffness tend to last in osteoarthritis?

< 30 minutes

14

Osteoarthritis (does / doesn't) affect the DIP joints.

does

15

At which joints do:

a) Heberden's nodes

b) Bouchard's nodes

form during osteoarthritis?

a) DIP joint

b) PIP joint

16

Bony enlargements seen in osteoarthritis are (soft / hard).

hard

17

Just as in RA, osteoarthritis may cause ___ of the thumbs.

squaring

18

What is a Baker's cyst?

Swelling in the popliteal fossa

19

Where is hip pain felt?

"Hip pain" described by patients may actually be caused by osteoarthritis of ___ joints.

groin

back joints

20

When does osteoarthritis tend to start?

40s onwards

21

Osteoarthritis is more common in (men / women).

women

22

Occupations involving a lot of heavy ___ accelerate the onset of OA.

labour

23

What are some underlying conditions which can accelerate the onset of OA?

RA

Gout

Acromegaly

24

What type of arthritis must be excluded when taking a history from patients?

Septic arthritis

25

The inflammatory markers of OA patients are usually ___.

normal

26

What are some X-ray features of OA?

LOSS:

Loss of joint space

Osteophytes

Sclerosis

Subchondral cysts

27

What are the primary hand joints affected in OA versus RA?

OA - DIPs

RA - PIPs, MCPs

28

How do joints feel in OA versus RA?

OA - hard, bony

RA - soft, hot and tender

29

When is stiffness at its worst in OA versus RA?

At the end of the day as opposed to in the mornings

30

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

31

What non-pharmacological therapies may OA patients require?

Physiotherapy

Weight loss

Occupational therapy - footwear, mobility aids

 

 

32

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

33

If OA has progressed to a point where it causes constant pain or reduced mobility, patients may be referred for ___.

surgery

34

What are the most common joint replacements carried out by the NHS?

Knee

Hips

(Uncommonly shoulder, elbow, fingers)

35

What are the two main crystal arthropathies?

Which crystals cause them?

Gout (uric acid)

Pseudogout (calcium pyrophosphate)

36

What is gout?

Inflammatory arthritis caused by uric acid crystals deposited in joints

37

Gout is more common in (men / women).

men

38

What is the metabolic product responsible for gout?

Purines

39

Apart from being a metabolite of food, purines are also produced when cells are __ __.

broken down

40

What is the biochemical pathway producing uric acid?

Diet

Purines

Xanthine

Uric acid

(simplified)

41

How is uric acid excreted?

Via urine

42

What is hyperuricaemia?

Serum uric acid > 7 mg/dL

43

Why can people with psoriasis develop gout?

High cell turnover

44

Does everyone who is hyperuricaemic develop gout?

No, don't blindly treat without symptoms

45

What change re: uric acid actually causes gout?

Acute changes in uric acid level

46

What is the main presentation of gout?

Rapid onset of severe pain in joint

 Bright-red, hot, lasts up to 2 weeks

47

What are the most common sites for gout?

Hallux

Ankle

Knee

can affect upper limb and spine too

48

Which medications can cause gout?

Diuretics

49

What must be excluded in someone with a hot, swollen joint?

Septic arthritis

50

What are depositions of uric acid in the skin called?

Tophi

51

In gout, inflammatory markers will be (raised / reduced).

raised

52

WCC may be raised in gout - what must be excluded at this stage?

Infection

osteomyelitis, cellulitis, septic arthritis...

53

X-rays appear normal in acute attacks of gout. How may they appear after chronic attacks?

Erosions

Osteophytes

Joint destruction

54

What is the gold standard investigation for gout?

Joint aspirate

55

How is an acute attack of gout managed?

NSAIDs for pain

(If contraindicated, colchicine)

(If both contraindicated, steroids)

And loads more analgesia (paracetamol, opiates)

56

What is an inconvenient side effect of colchicine?

Diarrhoea

57

What are some lifestyle recommendations for gout patients?

Reduce protien intake - red meat, beans, shellfish

Reduce alcohol intake

Lose weight

Drink plenty of fluids (but not fizzy drinks)

58

What drugs are used as prophylaxis for gout?

Which enzyme do they inhibit?

Allopurinol or Febuxostat

Xanthine oxidase

59

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

60

Pseudogout is more common in (young / old) people.

Which crystal is deposited?

old

calcium pyrophosphate

61

What shape are the crystals seen in:

a) gout

b) pseudogout?

Gout - needle shaped crystals

Pseudogout - rhomboids

62

Can patients have both gout and pseudogout?

Yeah

63

Is allopurinol used in pseudogout?

No - xanthines not involved

64

How is pseudogout treated?

NSAIDs / colchicine / steroids

Rehydration