Musculoskeletal System Disorders PDF

Chapter 10: Musculoskeletal System Disorders MUSCULOSKELETAL SYSTEM DISORDERS Introduction 1. 2. 3. 4. hints to the correct diagnosis. normocytic anemia seen on complete blood count (CBC), an elevated erythrocyte sedimentation with systemic lupus, but it can also be present in other diseases, such a...

Chapter 10: Musculoskeletal System Disorders MUSCULOSKELETAL SYSTEM DISORDERS Introduction 1. 2. 3. 4. hints to the correct diagnosis. normocytic anemia seen on complete blood count (CBC), an elevated erythrocyte sedimentation with systemic lupus, but it can also be present in other diseases, such as rheumatoid arthritis and Page 303 ALU 201: Intermediate Medical Life Insurance Writing “biologic” therapies are increasingly used to treat rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, with results exceeding those previously seen with conventional therapies. the proximal interphalangeal or PIP joints. These are commonly involved in both osteoarthritis phalangeal or MCP joints. These are commonly involved in rheumatoid arthritis. They are much most involved in osteoarthritis. tendonitis and bursitis. spondylitis. The thoracic and lumbar spines are never involved in rheumatoid arthritis, but the Page 304 Chapter 10: Musculoskeletal System Disorders in psoriatic arthritis. eye (i.e., uveitis, iritis) or bowel involvement (e.g., ulcerative colitis) can point to a seronegative or gout. Arthritis and musculoskeletal disorders are among the most common chronic conditions. They potentially leading to disability. Fatigue and mood disorders are common in individuals with arthritis and other chronic diseases and can be disabling. Cardiovascular disease risk is increased Osteoarthritis Page 305 ALU 201: Intermediate Medical Life Insurance Writing hips and knees). Various rarer metabolic disorders, such as acromegaly and hemochromatosis, are associated with accelerated osteoarthritis as well. and intermittent, rather than continuous and severe, as it is with rheumatoid arthritis. Treatment includes simple measures such as weight loss and exercise, which can be extremely ® ) are ® steroids are not used. Viscosupplementation injections with hyaluronic acid or similar agents can osteoarthritic joints, with total hip and knee replacements having revolutionized the management Page 306 Chapter 10: Musculoskeletal System Disorders Spinal Osteoarthritis The above discussion concerns osteoarthritis in the peripheral skeleton. The cervical, thoracic, between the vertebrae change with aging, gradually lose their elasticity, and become compressed. is nerve root or spinal cord compression. Most individuals are treated with conservative measures particularly at older ages. bony spurs at tendon or ligament insertions such as at the elbows, heels or around the pelvis. onset is in the middle decades, though it can occur in children and in the elderly as well. There is no Page 307 ALU 201: Intermediate Medical Life Insurance Writing 1. male gender 2. 3. 4. 5. 6. a combination known as sicca syndrome. activity are used, including the disease activity score (DAS) and clinical disease activity index damage and disability. Simple measures such as disease education as well as physiotherapy and ), and ). Patients not controlled on these drugs progress to “biologic” therapies ® ® Page 308 ® ® cardiovascular events, and malignancies. therapy. Mortality studies indicate that rheumatoid arthritis, particularly when severe, is associated with 1. 2. multiple joint involvement 3. 1. ankylosing spondylitis (AS) 2. psoriatic arthritis (PsA) 3. 4. reactive arthritis. Page 309 ALU 201: Intermediate Medical Life Insurance Writing Ankylosing Spondylitis activity. The pain tends to be in the lumbar spine and sacroiliac joint regions and then works its involved. early on, but characteristic changes eventually develop symmetrically in the sacroiliac joints and osteoporotic spine, which can occur with minor trauma. This can be devastating in the neck area, resulting in spinal cord compression. mortality associated with ankylosing spondylitis. Psoriatic Arthritis Psoriasis is a very common skin condition characterized by scaly plaques developing on the skin Page 310 spine and sacroiliac joints can mimic ankylosing spondylitis, though psoriatic spondylitis tends ® ® ® ), as well as an oral targeted PDE4 inhibitor ® ® to severe. diarrheal illness caused by various bacteria (e.g., salmonella, shigella, yersinia, or campylobacter). 1. also involve the spine, like ankylosing spondylitis 2. urethritis 3. conjunctivitis. tendon and ligament insertions into bones (i.e., enthesitis), such as at the Achilles tendon insertion into the heel is also common. Page 311 ALU 201: Intermediate Medical Life Insurance Writing There is usually no impact on mortality. Both ulcerative colitis and Crohn’s disease can be associated with arthritis. The peripheral bowel disease, rather than to the associated arthritis or spondylitis. elevated. Between attacks, individuals can be completely asymptomatic. Some individuals have uric acid (tophi) can develop in the joints and over pressure points, such as the external ears or Page 312 ® ). ), is ® ® In addition to the monosodium urate crystals associated with gout, other crystals can cause injection. There is no proven preventive therapy, and no associated increase in mortality. 1. 2. 3. or discoid lupus or Acute cutaneous lupus 4. 5. 6. 7. 8. lupus nephritis 9. 10. 11. criterion in each domain is counted toward the total score. At least one clinical criterion must be Page 313 ALU 201: Intermediate Medical Life Insurance Writing The clinical course and prognosis are quite variable. Some individuals have a mild illness organs can also occur. ) is ® drugs, such as azathioprine (Imuran® ® ® (Benlysta® ) orally or intravenously is ® ) ® In the past, systemic lupus had a very poor prognosis. Most individuals diagnosed had relatively 1. 2. 3. Page 314 are lung, heart, and kidney involvement. with proton pump inhibitors. Bacterial overgrowth in the bowel is treated with rotating courses ® scleroderma. Typically, there is muscle weakness in the shoulder and pelvic girdles as well as in the neck There can be mild arthritis as well. associated with an underlying malignancy that may not be clinically evident when the myositis Page 315 ALU 201: Intermediate Medical Life Insurance Writing dryness in the nasal passages, throat, vagina, and skin. Sjogren’s also have rheumatoid arthritis or other connective tissue diseases, such as lupus. the salivary glands. some patients. are used to make a diagnosis. ® ) or cevimeline (Evoxac® can improve nasal dryness. ® by reducing joint pain and rash. Those with rare but serious systemic symptoms can require ® ), ® ® ® azathioprine (Imuran ), mycophenolate (Cellcept ) or cyclophosphamide (Cytoxan ). Page 316 ® ) and other biological therapies to treat in some ways, though the symptoms tend to be more proximal and involve the muscles more than vessels in the muscle and likely around the joints as well. also be used as a diagnostic tool. polymyositis, and other rheumatic diseases such as rheumatoid arthritis or other connective tissue Treatment with corticosteroids prevents blindness in giant cell arteritis and rapidly relieves the Page 317 ALU 201: Intermediate Medical Life Insurance Writing dose aspirin. Vasculitis Osteoporosis than was previously thought. result in osteoporosis as well. 1. increased age Page 318 2. 3. 4. smoking 5. heavy alcohol use. Between –1.0 and –2.5 that the maximum bone mass is attained in individuals during their younger years. treatment. There are controversies regarding how long bisphosphonate therapy should be given, Denosumab (Prolia® romosozumab (Evenity® ), synthetic parathyroid ), and the newer abaloparatide (Tymlos ). Calcium and vitamin D ® ® ® Page 319 ALU 201: Intermediate Medical Life Insurance Writing uncommon. In asymptomatic individuals, no treatment is required. In individuals with symptoms and generally not shortened in this condition. 1. 2. 3. Page 320 www.arthritis.ca & www.rheumatology.org.