4. DISORDERS AND / OR ADVERSE REACTIONS - MUSCULO-SKELETAL SYSTEM - SUMMARY

4. DISORDERS AND / OR ADVERSE REACTIONS - MUSCULO-SKELETAL SYSTEM- SUMMARY

( Ref- Harrisons - Priniciples of Internal Medicine Ninth Edition )

1. Rheumatoid Arthritis ( 1872 )
2. Juvenile Rheumatoid Arthritis ( 1879 )
3. Ankylosing spondylosis ( 1880 )
4. Reiters Syndrome ( 1883 )
5. Osteomyelitis ( 1889 )
6. Cervical spondylosis( 2016 )
7. Gout ( 479 )
8. Myopathy or myalgia ( 2072  )
9. Bone disorders ( 389 )
10. Osteomalacia (1854)
11. Osteolysis (1866)
12. Multiple myeloma (334)
13. Pagets Disease (1860)
14. Degenerative Joint disease (1894)
15. Progressive Systemic Sclerosis ( Diffuse Scleroderma (1896)
16. Hypertrophic osteoarthopathy (1900)
17. Neuropathic Joint Disease (1900)
18. Tietzes syndrome (1902)
19. Bursitis and Tenosynovitis (1902)
20. Fibrisitis (1903)
21. Carpal Tunnel Syndrome (1903)

1. Rheumatoid Arthritis ( 1872 )

Rheumatoid arthritis (RA) is a chronic sytemic disease of unknown etiology, manifested primarily
by inflammatory arthritis of the peripheral joints,usually in a symetrical distribution. Systemic
manifestations include hematologic,pulmonary, neurological and cardiovascular abnormalities.

2. Juvenile Rheumatoid Arthritis ( 1879 )

Juvenile arthritis (JRA) consists of several distinct syndromes. Three main subgroups have been
 identified: systemic-onset disease, polyarticular disease, and pauciarticular disease. In addition,
 ankylosing spondylosis and rheumatoid arthritis  indistinguishable from adult onset disease may
begin from childhood.

3. Ankylosing spondylosis ( 1880 )

Ankylosing spondylosis, a disease that has been called by many names, including rheumatoid
spondylosis and Marie-Strumpell disease, is a chronic and usually progressive inflammatory
disease invloving the articulations of the spine and adjacent soft tissues. The sacroiliac joints
are always affected. Involvement of the hip and shoulder joints commonly occurs: peripheral
joints are affected less frequently

The disease predominantly affects young men and begin most often in the third decade.
A high association has been found between this disorder and the histocompatibility antigen
HLA-B27. The clinical features of this disease are distinctly different from those of rheumatoid
 arthritis. The etiology is unknown.

4. Reiters Syndrome ( 1883 )

Reiters syndrome is characterized by arthritis, urethritis, conjunctivitis, and mucocutaneous
lesions. The complete syndrome may not be present at any given time. The diagnosis should
be entertained when arthritis is associated with any of the other manifestations. The HLA-B27
is present in majority of the patients. 

5. Osteomyelitis ( 1889 )

Osteomyelitis denotes infection of bone. While many types of microorganisms, including viruses
 and fungi may cause ostyeomyelitis, it is usually bacterial in origin

6. Cervical spondylosis( 2016 )

The cervical intervertebral disks degenerate to some degree in the majority of individuals by
the sixth and seventh decades of life. This results in narrowing of the disks especially in the
most mobile parts of the cervical spine (fourth to fifth cervical, fifth to sixth cervical, sixth to
seventh cervical and seventh cervical to first thoracic segments) and spur formation on the
margins of the adjacent vertebrae.

There are anterior beaking and posterior osteophytes which protude centrally with narrowing
 of the spinal canal or laterally so as to impinge on  spinal roots in the intervertebral canal.
 This condition is incorrectly called hypertrophic arthritis, but there is no consistent association
 with arthritis of this type of joints. The more appropiate  term cervical spondylosis refers to a
  wear and tear (traumatic) phenomenon.

7. Gout ( 479 )

Gout is the term representing hetrogenous group of diseases found exclusively in humans which
   in their full development are manifested by -

a. an increase in serum urate cocentrations
b. recurrent attacks of characterstic type of acute arthritis in which crystals of monosodium urate
 are demonstrable   in leukocytes of synovial fluid
c. aggregated deposits of monosodium urate monohydrate( tophi) chiefly in around the joints
    of the extremities and sometimes leading to severe crippling or deformity
d. renal disease involving intestinal tissues and blood vessels and
e. uric acid nephrolithiasis

These may occur singly or in combination

8. Myopathy or myalgia ( 2072  )

Myalgic states- diffuse muscle pain, which merges with malaise, is  a frequent expression of
a large variety of systemic infections eg. influenza, brucellosis, dengue , measles, malaria,
rheumatic fever.  When this pain is remarkbly intense and especially if it is localized to one
group of muscles, the most  likely diagnositic possiblity is epidemic myalgia
 
  Adverse reaction- drugs (389 )
   1. Corticosteroids
   2. Chloroquine
   3. Clofibrate
   4. Oral contraceptives
   5. Amphotericin B
   6. Carbenoxolone

9. Bone disorders ( 389 )

  Adverse reaction- drugs
    Osteoporosis 
    1. Corticosteroids
    2. Heparin

    Osteomalacia
     1. Anticonvulsants  
     2. Glutethemide
     3. Aluminium Hydroxide

10. Osteomalcia - (1854)

The term -rickets and osteomalicia- are used to describe a group of disorders in which there is a
defective mineralization of the newly formed organic matrix of the skeleton. In rickets the growing
skeleton is involved; defective  mineralization occurs not only in bone but also in the cartilaginious
matrix of the growth plate.

The term Osteomalacia is usually reserved for the disorder of the mineralization of the adult skeleton
in which the epiphysical growth plates are closed. There are number of conditions that result  in rickets
and/or osteomalacia, such as inadequate dietary intake of Vitamin D, inadequate exposure to
ultraviolet radiation to form exogenous vitamin D , chronic acidosis, renal tubular defects, which
produce hypophosphatemia or  acidosis and chronic administration of anticonvulsants

11. Osteolysis (1866)

The skeleton is one of most common sites of metases  from carcinoma and sercomas. Skeletal
muscles may be relatively silent or produce symptoms by the same mechanism that primary tumors
do- ie pain, swelling, deformity of a bone, encroachment on hematopoietic tissue in the marrow,
compression of the spinal cord or  nerve roots and pathological features. The carcinoma that most
frequently metastasize to bone arise in prostrate, breast, lung, thyroid, kidney and bladder

Osteolysis most often results from stimulated modulation of osteoprogenerator cells to osteoclast
in the surrounding bone. Parathyroid  hormone-like polypeptides , prostagladins and the protein-
containing factors ( osteoclast-activating factor) may function to stimulate modulation of osteoclasts
from progenitor cells and increase the functional activity of osteoclast already present.

 Some carcinoma cells may also act directly to reabsorb bone. Examples of carcinomatous
 metastases (which are predominently osteolytic ) are arising from thyroid, kidney, and lower
 bowel

12. Multiple myeloma (334)

Multiple myeloma is a disseminated malignancy of plasma cells that may be associated with
bone destruction, bone marrow failure, hypercalcemia, renal failure and recuurent infections.
The disease is most common in the middle-aged and elderly, the median age of occurance is
60 years. Males are slightly more affected slightly more frequently than the females. The annual
incidence of the disease is about 3 per 100,000 population

13. Pagets Disease (1860)

The Pagets disease of the bone ( osteitis deformans ) is among the most common of the chronic
 skeletal diseases. In the strict sense it is a focal disease, although occassionally it may be
  widespread. Histologically the intitial event is excessive resorption of bone mediated cells such
as osteoclasts, followed by replacement of bone marrow by vascular , fibrous connective tissue.

14.Degenerative Joint disease (1894)

Degenerative joint disease (DJD)  is characterized by loss of joint cartilage and by hypertrophy
of bone. Symptoms of degenerative disease include osteoarthiritis and hypertrophic arthitritis.
The exact mechanism of cartilage loss in DJD has not been defined, but stress and subchordral
bone changes  contribute to damage. Treatment  of DJD is directed to amelioration of symptoms,
decrease in excessive stress, and corrective procedures in properly selected subjects.

15. Progressive Systemic Sclerosis ( Diffuse Scleroderma (1896)

Progressive systemic sclerosis (PSS)  is a disorder of connective tissue leading to fibrosis that
invloves the skin (scleroderma) and a variety of internal organs, mostly notably the gastrointestinal
tract, lungs, heart, and kidney. The clinical hallmark of PSS is the tight, firm skin, which may be
present several years before visceral invlovement becomes apprarent

16. Hypertrophic osteoarthopathy (1900)

Hypertrophic osteoarthopathy is characterized by the presence of periosteal inflammation and
new bone formation, arthiritis, and clubbing of the digits. This syndrome frequently results from
disorders in the lungs, and hence frequently called hypertrophic pulmonary ostoeoarthopathy or
secondary hypertrophic osteoarthiritis. It also occurs in association with disorders of other agents,
as well as familial and idiopathic forms.

17. Neuropathic Joint Disease (1900)

Neuropathic joint disease also called Charcot joints, develops in a variety of neurological disorders
in which proprioception and/or deep pain sensation are disrupted. Increased trauma and stress are
thought to occur during joint motion because of relaxation of the supporting structures of the joint.
This leads to degeneration of cartilage , recurrent fractures of subchondral bone, and marked
proliferation of adjacent bone.

Neuropathic joint discease generally involves the knees, hips, ankles, and the lumber spine in
tabes dorsatis , the tarsometatarsal , metatatarsophangel, and tarsal joints in  diabetic neuropathy,
and the shoulders, elbows, and cervical spine in syringomyella

18. Tietzes syndrome (1902)

Tietzes syndrome consists of swelling, pain, and tenderness in the upper costochondral  cartilages.
The cause of this disorder is unknown. This syndrome tends to evolve gradually but may be acute.
Patients often associate the onset with trauma. The involved costochondral joints are swollen and
tender but not warm, and the disorder must be differentiated from bacterial infections, rheumatoid
arthiritis and other inflammatory arthiritides.

19. Bursitis and Tenosynovitis (1902)

Bursitis is defined as an inflammation of unknown cause of any of the many bursas between
tendons, muscles, and bony prominences. The most common type of bursiritis occurs in the shoulder.
Other common types of bursitis are  trochanteric bursitis ( bursas  around the gluteus medius
insertion to the trochanter of the femur ) which causes pain or external rotation of the hip

Tenovitis ( inflammation of the synovial lining of tendons) occurs with other types of rheumatic
disease (rheumatoid arthiritis, systemic lupus eryhthematous, gout ) in bacterial infections,
(gonococcal , tuberculous) secondary to  trauma and without known causes (idiopathic)

20.Fibrisitis (1903)

Fibrositis is a term used for an ill-defined , poorly understood set of symptoms, consisting of aching
pain, and stiffness in one or several parts of the body. These symptoms occur deep in tissues,
including muscles , tendon insertions and bony prominences
 

21. Carpal Tunnel Syndrome (1903)

Carpal tunnel syndrome , also called entrapment neuropathy, may be due to tenosynovitis,
trauma, edema, fibrosis, tubrculosis, and other granulomatous  diseases, rheumatoid arthiritis,
acromegaly,amyloidosis, edema, of pregnancy, and premunstrual edema. Localized tenosynovitus
of unknown cause is the most common basis  of the carpel tunnel  syndrome, paricularly in the middle
aged females.

It is caused by the pressure on the median nerve as it passes through the space formed by the bones
 of the wrist and transverse carpal ligament.