Disease of Joints and Musculoskeletal Disorders


  • Also called degenerative joint disease.
  • Hip osteoarthritis is more common in men and small joints and knee OA is more common in women.
  • There is damage to cartilage, remodeling and hyper­trophy of bone.
  • There is bone and muscle wasting.

OSTEOARIRITIS Clinical Features

  • · There is deep pain in the joint aggravated by joint movements and relieved by rest.
  • · There is involvement of synovium, subchondral bone, ligament, capsule, muscle and formation of osteophytes.
  • · Nocturnal pain, stiffness, synovitis.
  • · There is bony crepitus over affected joints and synovial effusion.
  • · There may be ‘bony deformities.
  • · Fever, weight loss may occur.

Lab findings

  • · In X-ray joint-space narrowing is seen
  • · Osteophytes.


  • Obese patient should lose weight
  • Avoid prolonged standing, kneeling, squatting Medial taping of patella
  • Wedged insoles in footwear
  • Heat application – hot bath
  • Walking, cycling, swimming reduces joint pain Walking with a cane during pain
  • Proper footwear
  • Analgesics
  • Paracetamol Cox-2 inhibitors Ibuprofen Naproxen
  • Intraarticular injection of hyaluronidase Steroids –
    • intraarticular should not be given Opioids
    • Tramadol
  • Tidal irrigation of knee
  • Topical therapy – Pain relievers – ointments, sprays, oils
  • Glucosamine, chondroitin sulphate – it protects the cartilage and gives symptomatic improve­ment
  • Surgery – Joint replacement, osteotomy, arthro­plasty
  • Chondroplasty.

Disease of Joints and Musculoskeletal Disorders OSTEOARTHRITIS and GOUT


  • · It is a metabolic disease
  • · Affects middle-aged and elderly men and women.
  • · There is hyperuricemia ( increased levels of uric acid in blood)
  • · There is acute or chronic arthritis with deposi­tion of monosodium urate(MSU) crystals in con­nective tissue and kidneys
  • · Usually only one joint is affected
  • · The great toe (first toe) is involved
  • · There are Heberden’s nodes or Bouchard’s nodes in the joints
  • · Joints are warm, red, painful
  • · It is precipitated by alcohol, steroids, MI, stroke
  • · Renal insufficiency may occur.

GOUT Lab Diagnosis

  • · MSU crystals can be demonstrated in the joint
  • · Serum uric acid may be increased, normal or low
  • · X-ray –bony erosions may be seen.

GOUT Treatment

  • For acute attack Colchicine is given – 0.6 mg every hour till relief. Colchicine is stopped if there is diarrhoea
  • NSAIDs
  • Steroids
  • Indomethacin
  • Ibuprofen
  • ACTH – 40 – SO IU every 12 hours for 2 days. Uricosuric agents – probenecid, allopurinol given to increase excretion of uric acid.
  • They prevent acute attacks but are not started during an attack of painful gout because they can flare-up the attack.
  • Allopurinol is given in a single dose 300 mg ini­tially and increased upto SOO mg.
  • Toxicity of allopurinol is skin rash, systemic vas­culitis, hepatitis, bone-marrow suppression and renal failure.
  • Hypourecemic therapy is given till the patient is normourecemic and without gouty attack for 3 months. Prophylactic colchicine may be contin­ued.


  • Usually caused by Staphylococcus aureus, Neisseria gonorrhoea.
  • Also caused by Mycobacteria, spirochetes, fungi, vi­ruses.
  • One or more joints involved.
  • Affects the knee, hip, shoulder, wrist, elbow joints. There is severe pain, effusion, limitation of move­ments. Fever is usually present.
  • X-ray show,? swelling and increase of joint-space. MRI and CT’may be done.
  • Synovial fluid is turbid or purulent.
  • Gram’s staining shows neutrophils and staphylococci. Culture of synovial fluid is usually positive.


  • Antibiotics oral or parenteral Drainage of joints
  • Antibiotics – Cefotaxime, Ceftriaxone, Vancomy­cin instilled into joints
  • Weight- bearing should be avoided till infection subsides.


  • It is a non-purulent arthritis.
  • It usually occurs after enteric or urogenital infections. It has a strong association with HLA B27 antigen. Age: commonly lS – 40 years.
  • Sex: males and females are equally affected.


  • There is synovial inflammation, infiltration of the soft tissues of joint, cartilages with inflammatory cells.


  • Any bacterial, viral or parasitic infection can lead to reactive arthritis.
  • Shigella, Salmonella, Clostridium etc. cause reactive arthritis commonly.
  • The disease is mediated by T cells-CD4+ and CDS+.

REACTIVE ARTHRITIS Clinical features

  • Constitutional symptoms-fever, malaise, weight loss, fatigue.
  • There is asymmetric arthritis from 1 – 2 weeks after an infection.
  • Joints of lower extremities like knees, ankle, tarsal, and metatarsal joints are affected.
  • Wrist and fingers are also affected.
  • Dactylitis –
    • Swollen fingers like a sausage called sau­sage-digit may be seen.
  • Tendonitis.
  • Chronic pain in the heels. Pneumonia. Pleuropulmonary infiltrates. Prostatitis.
  • Keratoderma blenorrhagica – Skin lesions with vesicles, crusting on palms and soles are seen.
  • Nails turn yellowish, brittle. There is onicholysis (nails break up), hyperkeratosis of nails.
  • Cardiac involvement – conduction defects, aortic re­gurgitation may occur.

Lab tests

  • · ESR increased
  • · Anaemia
  • · HLA B-27 positive
  • · X-ray
  • – Osteoporosis especially juxta articular (close to the joints)
  • – Sacroileitis
  • – Periosteitis
  • – Spinal fusion.


  • NSAIDs –
  • Indomethacin,
  • Cox-2 inhibitors
  • Sulphasalazine
  • Azathioprine – 1 mg/kg/day
  • Methotrexate – 15 mg/kg/week
  • Glucocorticoids.


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