Osteoarthritis and Low Back Pain Management

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Questions and Answers

What is the first-line drug treatment recommended for osteoarthritis?

Regular paracetamol (correct)

Opioids

Low-dose antidepressants

Topical NSAIDs

Which of the following multidisciplinary team members would you refer to for foot care and insoles?

Physiotherapist

Chiropodist (correct)

Occupational Therapist

Social Worker

Which self-management strategy can help alleviate symptoms of knee osteoarthritis?

Avoiding physical activity

Weight reduction (correct)

Increased sugar intake

Prolonged bed rest

What should be co-prescribed with NSAIDs for patients taking them for more than one week?

Proton pump inhibitors Signup and view all the answers

Which type of exercises are particularly recommended for patients with limited mobility due to osteoarthritis?

Isometric exercises Signup and view all the answers

What is an effective method for managing pain in osteoarthritis before considering medications?

Local heat/cold treatments Signup and view all the answers

Which option is a commonly used topical treatment for knee and hand osteoarthritis?

Capsaicin cream Signup and view all the answers

What lifestyle modification can improve outcomes for patients with hip osteoarthritis?

Using a walking stick in the opposite hand Signup and view all the answers

What characterizes acute low back pain?

A new episode lasting less than 3 months Signup and view all the answers

Which symptom suggests that low back pain may be inflammatory in nature?

Pain easing with movement Signup and view all the answers

What aspect should be excluded when evaluating back pain?

Pain originating from gastrointestinal issues Signup and view all the answers

When examining a patient for low back pain, which finding indicates potential inflammation?

Palpable tenderness over the spine Signup and view all the answers

Which sign is typically tested with a straight leg raise (SLR) during physical examination?

Sciatica Signup and view all the answers

What should be assessed to evaluate severity during a back pain examination?

Ability to lie down comfortably Signup and view all the answers

Which of the following is NOT a history detail that should be collected for low back pain?

Family history of COPD Signup and view all the answers

What kind of deformity is typically found in ankylosing spondylitis?

Kyphosis Signup and view all the answers

What is the most significant reason that patients with osteoarthritis seek medical help?

Pain Signup and view all the answers

Which factors influence the level of pain and disability experienced by patients with osteoarthritis?

Personality and mental health Signup and view all the answers

Which joints are most commonly affected by osteoarthritis?

Hips, knees, and base of the thumb Signup and view all the answers

What is a common familial tendency associated with nodal osteoarthritis?

Swelling of the distal interphalangeal joints (Heberden’s nodes) Signup and view all the answers

How is osteoarthritis classified in terms of its underlying process?

A metabolically active process involving the whole joint Signup and view all the answers

Which of the following factors is NOT a recognized risk factor for osteoarthritis?

Excessive physical activity Signup and view all the answers

What might investigations such as X-rays reveal in a patient with osteoarthritis?

Osteophytes and subchondral bone sclerosis Signup and view all the answers

What does the management of osteoarthritis in primary care typically involve?

A holistic approach Signup and view all the answers

What is a recommended course of action for patients considering steroid treatments for osteoarthritis?

Consider a trial of a single long-acting steroid injection. Signup and view all the answers

Which complementary therapy is widely reported to be used by osteoarthritis sufferers but is generally not recommended?

Hyaluronic acid knee injections Signup and view all the answers

What is the main reason for referring a patient suspected of rheumatoid arthritis to rheumatology?

For early treatment with disease-modifying drugs. Signup and view all the answers

Which of the following has shown limited effectiveness in treating conditions other than back pain?

Chiropractic therapy Signup and view all the answers

What is a common psychological factor affecting patients with osteoarthritis?

Depression and anxiety Signup and view all the answers

What is the controversy surrounding the use of glucosamine in osteoarthritis management?

Its impact on OA progression is unclear. Signup and view all the answers

What should practitioners ensure when advising patients about complementary therapies?

That the practitioner has accredited training and professional indemnity insurance. Signup and view all the answers

For which condition should patients with severe osteoarthritis symptoms potentially be referred to orthopedic specialists?

Joint sepsis suspected Signup and view all the answers

What is a common feature of the hands in rheumatoid arthritis?

Ulnar deviation of the fingers Signup and view all the answers

Which deformities are characteristic of the thumb in rheumatoid arthritis?

Z deformity and Boutonnière deformity Signup and view all the answers

What condition may develop in the knee area of patients with rheumatoid arthritis?

Baker’s cyst Signup and view all the answers

What complications might arise from cervical spine involvement in rheumatoid arthritis?

Cord compression from atlanto-axial instability Signup and view all the answers

What is a feature associated with Felty’s syndrome in rheumatoid arthritis patients?

Recurrent infections and splenomegaly Signup and view all the answers

What non-articular manifestation is commonly seen in patients with rheumatoid arthritis?

Pleural effusions and pulmonary nodules Signup and view all the answers

What role does C-reactive protein (CRP) play in the assessment of rheumatoid arthritis?

Acts as a marker for acute inflammation Signup and view all the answers

Which of the following is NOT increased by rheumatoid arthritis?

Grip strength Signup and view all the answers

What is the most common joint affected during an acute gout attack?

Big toe Signup and view all the answers

Which of the following conditions is a risk factor for developing gout?

Obesity Signup and view all the answers

What type of crystals are typically found in the synovial fluid of a gout patient?

Sodium monourate Signup and view all the answers

Which imaging finding might indicate chronic gout?

Erosive pattern of the joint Signup and view all the answers

Which of the following best describes the clinical presentation of chronic gout?

Recurrent acute attacks and tophi formation Signup and view all the answers

In the context of gout, what can trigger acute attacks?

Acute infections Signup and view all the answers

What is the primary cause of calcium pyrophosphate deposition disease (CPPD)?

Pyrophosphate crystal deposition Signup and view all the answers

How may calcium pyrophosphate deposition disease present on X-ray?

Chondrocalcinosis Signup and view all the answers

Study Notes

Musculoskeletal Problems

Chapter 14 of the text discusses musculoskeletal problems, covering a range of symptoms and conditions, including neck pain, low back pain, shoulder and elbow problems and more.
The text also details various symptoms of musculoskeletal disease, bone disorders, sports medicine, management of sporting injuries, and different types of arthritis (osteoporosis, osteoarthritis, rheumatoid arthritis, etc.).
Symptoms of musculoskeletal conditions often include pain, stiffness, and loss of function.
Examination of musculoskeletal issues often includes assessments of deformity, tenderness, muscle spasm, range of motion, and neurological function.
Management approaches discussed include community triage, analgesic use, and possible specialist referrals based on the patient's history and examination.

Low Back Pain

Acute low back pain lasts less than 6 weeks
Chronic low back pain lasts longer than 3 months.
Prevalence of back pain in a lifetime is 58%.
Causes of back pain can be evaluated via history regarding circumstances of pain, nature/severity, associated symptoms, past medical history and excluding pain that isn't spinal.
Examination includes assessing deformity, palpation for tenderness, and assessing movement.
Patients without specific red flag symptoms might initially be managed with analgesia, avoiding bedrest, promoting activity, and potentially using self-help exercises.

Acute Back Pain

History of trauma is a crucial factor in assessing acute back pain.
Cauda equina syndrome and rapidly progressive neurological deficit are serious concerns requiring immediate admission.
Simple mechanical backache in otherwise healthy individuals may resolve within 4 weeks with conservative management.
Assessing "yellow flags" (psychosocial factors that inhibit recovery) is crucial for management.

Scoliosis

Lateral curvature of the spine and potential rotation of vertebrae.
Early detection and intervention may help prevent complications.

Cauda Equina Syndrome

This is a critical neurological emergency
Cauda equina syndrome is characterized by bowel and/or bladder dysfunction (incontinence), or lower motor nerve weakness.

Shoulder Problems

Shoulder pain can be caused by various factors, including tendinitis, tears, impingement, and dislocations.
A "painful arc" can indicate impingement.
Shoulder examination assesses posture, tenderness, movement, and range of motion.

Elbow Problems

Common elbow problems include tendinopathies, instability, and dislocations.
History and examination include assessing pain, stiffness, deformity, and loss of function
Treatment for elbow conditions typically involves rest, ice, NSAIDs, and potentially specialized physiotherapy.

Osteoporosis

Lifetime risk of osteoporotic fracture is high (>200,000 cases annually in the UK).
Osteoporosis is diagnosed via T-score, which compares bone density to an average young adult.
Osteoporosis can be either primary (e.g., naturally occurring post-menopause) or secondary (e.g., due to underlying diseases).
Management includes lifestyle advice, medication (bisphosphonates, denosumab), and potential considerations for fracture prevention.
Treatment options like hormone replacement therapy and other drugs are sometimes considered depending on individual circumstances

Treatment Options for Osteoporosis

Lifestyle advice plays a huge role in managing osteoporosis.
Adequate nutrition, maintaining a healthy weight, regular exercise, smoking cessation, and limiting alcohol intake are essential.
Medications like bisphosphonates, Denosumab and Teriparatide often prescribed to prevent further fracture and/or bone loss.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disorder primarily affecting the small joints of the hands and feet.
Characterized by pain, stiffness, swelling, and inflammation.
Early diagnosis and treatment are crucial to managing the disease's progression and prevent irreversible joint damage.

Crystal-Induced Arthritis

Conditions like gout and pseudogout are forms of crystal-induced arthritis.
Gout typically causes acute, painful attacks in joints, often the big toe.
Pseudogout also presents similarly, however, presents with deposits of calcium pyrophosphate crystals in joints.

Further Information

Various resources—like specific organisations for arthritis, care, and support—are mentioned in the text for further information or guidance on these conditions.

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Description

This quiz focuses on key treatment strategies and self-management techniques for osteoarthritis and low back pain. Participants will explore medication options, lifestyle modifications, and the roles of multidisciplinary team members in managing these conditions. Test your knowledge on effective pain management methods and the characteristics of back pain.