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MSK High Yield MLA content Anki Style 1ALL ABOUT ARTHRITIS 2spondyloarthropathies what are they: Psoriatic arthritis reactive arthritis ankylosing spondylitis enteropathic arthritis What does this mean: associated with the gene -> HLA-b27 3Ankylosing spondylitis: presentations Epidemiology YOUNG DUDE Fx has LOW back pain with exerciseSE in morning but eases throughout day or Relevant PMH COMMON achilles tendonitis 4Ankylosing spondylitis: Inv + Mx INVSchober test Xray - bamboo spine/sacroilitis MRI - gold standard - bone marrow oedema (early signs) Mx Nsaids + physio Anti TNF 2nd line - usually proceeded in moderate to severe disease 5Reactive arthritis - Features Fx Has gastroenteritis/Sexual intervcourse 4 weeks prior symptom development ‘cant see, cant pee, cant climb a tree’ uveitis/conjuctivits urethrtitis/balanitis monoarthritis - lower limbs more common Most common STI that causes this? Inv - rule out septic and other causes management - NSAID - if reccurent MAYBE methotrexate 6Psoriatic arthritis Fx RF PIP joints vs PA DIP joints affected - if symmetrical polyarthritic can be asymmetrical oligoarthritic 2nd most common arthritis mutilans -> telescoping finger Relevant PMH psoriasis/skin changes pitting nails/oncholysis tendon problems e.g. achilles tendinitis Inv Xray - pencil in cup appearance mananagement - NSAID - 1st line/mild methotrexate is severe/moderate disease 7enteropathic arthritis Fx Any INFLAMMATORY joint pain + change in bowel habits in keeping with IBD THINK enteropathy Relevant PMH UC/Crohns - Mostly UC pyoderma gangrenosum Ant. Uveitis flare of bowel disease Inv UC - have Panca (70%) Xray/MRI - for axial disease - baso ankylosing spondylitis Fxs mananagement - CsDmards Biologics 8Rheumatoid arthritis - FX Fx swollen, painful joints in hands and feet stiffness worse in the morning gradually gets worse with larger joints becoming involved presentation usually insidiously develops over a few months positive 'squeeze test' - discomfort on squeezing across the metacarpal or metatarsal joints Late Features i swan neckiation boutenerres 9Rheumatoid arthritis - inv Inv Antibodies RF ANTI ccp which one better/specific Xrays Soft tissue swelling - easiest to identify juxta articular erosion - idk what this means periarticular osteoporosis 10Rheumatoid arthritis - mX Management Dmard monotherapy +/- steroids 1st line DMARds used for RF - Methotrexate most common sulfasazlazine leflunomide only use Biologics if disease is moderate - severe/have not responded to dmard’s How do you classify severity and what are the scores Das28 <2.1 - remission <3.1 mild 3.2-5.0 - moderatre >5.1 - severe 11Septic arthritis - Fx fx acute swollen joint restricted by movement erythema SYSTEMIC UPSET - fever FEVER + JOINT pain = SEPTIC arthritis inv synovial fluid analysis blood culture what is the most common organism vs most common in young patients? Management IV abx - 2 weeks then switch to oral for 4 weeks 12gout vs pseudogout fx BOTH - big fat monoarthritic inflammation Gout - big toe pseudogout - shoulder/wrist Relevant PMH/Fx Crystals fat don that has alcohol eating red meats/fish Gout - Uric acid pseudogout - calcium pyrophosphate inv synovial fluid analysis G = Negative befringement PG = positive befringement G = needle shaped PG = rhomboid shaped Xray G = punched out erosions PG = chondrocalcinosis Management NSAIDs both for gout specifically NSAID/colchine 1st allopurinol - when is this indicated and when should you take it? 13Osteoarthritis Fx Pain worse on exercise/movement older >45 improves with rest inv Xray L - loss of joint space O - osteophytes S - subchondral cysts S - subchondral sclerosis Management NSAIDs physio IA injection Surgery - last line 14fibromyalgia Fx Widespread pain >3 months sleep disturbance fatigue has psych condition inv clinical diagnosis Management neuropathic meds CBT 15Thanks 16OSCE MSK Hx HOPC SOCRATES PRISM - rheum focused - idont really use lol Pain Rashes, skin lesions and nail changes Immune Stiffness Ideas, concerns, expectations Malignancy PMH Swelling and sweats Ask specifically - psoriasis, STI, conjunctivitis, uveitis DH Relevant Systems review Ask specifically - thiazides (precipitate gout) Systems review Stiffness (ie. morning) Swelling, redness, heat Infections (STI, gastroenteritis, recent infections) Uveitis, iritis Spondyloarthropathy (back pain, stiffness in back) (rashes, mouth ulcers, dry eyes/ mouth, Raynaud’s phenomenon) 17OSCE MSK Xrays approach VIEW Is this AP or lateral Adequacy and alignment MOST IMPORTANT GIVEAWAY IS THE HISTORY SOymphasis basically look if its bent Bonis the dislocated/fracturesS DATA INTERP MAN what type of fracture - oblique/transverse where? Cartilage/joint space (if applicable) Soft tissues (if applicable) 1819synovial fluid analysis summary 20
