NLE Musculoskeletal Nursing — Degenerative, Inflammatory and Metabolic Bone DisordersCheat Sheet
A printable cheat sheet for Degenerative, Inflammatory and Metabolic Bone Disorders, built for NLE reviewers who want one go-to reference in the final stretch. Covers formulas, key definitions, common question types, and the Professional Regulation Commission (PRC) — Board of Nursing-specific twists you will see on NLE day.
Exam context
For the Philippine Nurse Licensure Examination (PNLE), Professional Regulation Commission (PRC) — Board of Nursing tests Musculoskeletal Nursing under a "Core" label, with Degenerative, Inflammatory and Metabolic Bone Disorders in the 3rd slot across 3 chapters. NLE candidates must clear the 75% weighted average with no sub-test below 60% cut on the 2026 paper, which draws about 50 Musculoskeletal Nursing questions. Date to watch: Bi-annual.
Degenerative, Inflammatory and Metabolic Bone Disorders - Cheat Sheet
Your last-minute revision companion for musculoskeletal nursing. Master OA vs RA distinction, gout management, osteoporosis prevention, hip precautions, and critical nursing diagnoses.
Sections
Section Title
Osteoarthritis (OA) vs Rheumatoid Arthritis (RA) — THE MASTER COMPARISON
Important Facts
- OA: Asymmetric, weight-bearing joints (knees, hips, spine, DIP fingers), pain worse with activity, stiffness <30 min
- OA: Heberden's nodes (DIP) and Bouchard's nodes (PIP) on fingers—pathognomonic
- OA: NO systemic signs (no fever, fatigue, weight loss)
- RA: Symmetric (bilateral), small joints first (hands, wrists, feet), pain worse in morning
- RA: Morning stiffness >1 hour is classic; systemic signs present (fatigue, low-grade fever, weight loss, malaise)
- RA: Labs—elevated ESR, CRP, positive rheumatoid factor (RF), anti-CCP antibodies
- RA: Deformities include ulnar deviation, swan-neck, boutonnière deformities
- OA: Non-inflammatory or low-inflammatory; RA: markedly inflammatory
Key Definitions
Term
Osteoarthritis
Example
60-year-old with Heberden's nodes on fingers and knee pain worse with activity
Definition
Degenerative, non-inflammatory, wear-and-tear joint disease with progressive cartilage loss, osteophyte formation, and asymmetric joint involvement.
Term
Rheumatoid Arthritis
Example
35-year-old with bilateral hand/wrist swelling, morning stiffness >1 hour, fever, positive RF and anti-CCP
Definition
Chronic, systemic, autoimmune inflammatory disease attacking synovial membrane, forming pannus and causing symmetric joint destruction with systemic manifestations.
Term
Pannus
Example
Seen on imaging as destructive lesions at joint margins
Definition
Inflammatory tissue mass in synovium that invades and erodes cartilage and bone in RA.
Diagrams To Know
- Side-by-side comparison of OA vs RA joint changes
- Timeline: OA progressive cartilage loss vs RA pannus formation and erosion
- Hand deformity patterns: Heberden's/Bouchard's vs ulnar deviation/swan-neck
Section Title
OA & RA Pharmacology & Nursing Management
Important Facts
- OA TREATMENT: Acetaminophen first-line, NSAIDs added, weight reduction, low-impact exercise, joint protection, heat for stiffness, cold for acute inflammation
- RA TREATMENT: Balance rest and activity, heat/cold, joint protection, DMARDs (especially methotrexate), NSAIDs, short-course corticosteroids, biologic agents
- METHOTREXATE: Anchor DMARD for RA—give FOLIC ACID to reduce side effects, monitor for hepatotoxicity and bone marrow suppression, TERATOGENIC (avoid pregnancy)
- NSAIDs: Contraindicated in renal disease, GI ulcers, aspirin sensitivity; monitor for GI upset, renal impairment
- BIOLOGICS (etanercept, infliximab): TNF-alpha inhibitors—increase infection risk; screen for TB before use; counsel on symptoms of infection
- Short-course CORTICOSTEROIDS: Control RA inflammation but not long-term curative; taper to prevent rebound
- NURSING: Teach joint protection, activity pacing, sleep hygiene, stress management, medication adherence; refer to OT/PT
Key Definitions
Term
DMARD (Disease-Modifying Antirheumatic Drug)
Example
Methotrexate, biologics (etanercept, infliximab)
Definition
Agents that slow or halt RA disease progression; methotrexate is anchor drug.
Term
NSAIDs
Example
Ibuprofen, naproxen, indomethacin
Definition
Anti-inflammatory analgesics; first-line for OA pain and RA inflammation, not curative.
Diagrams To Know
- Methotrexate side effects monitoring flowchart
- DMARD initiation and escalation pathway
Common Values
Value
<6.8 mg/dL
Symbol
SUA
Quantity
Normal serum uric acid
Value
>6.8 mg/dL
Symbol
Gout risk
Quantity
Hyperuricemia threshold
Section Title
Gout — Purine Metabolism & Acute Management
Important Facts
- GOUT CLASSIC SITE: Great toe (podagra); may also affect ankles, knees, wrists, fingers
- ACUTE ATTACK: Sudden onset, red, hot, swollen, exquisitely tender joint; lasts days to weeks
- TRIGGERS: High-purine diet, alcohol (especially beer), dehydration, diuretics, NSAIDs, leukemia treatment, acute illness
- DIET MANAGEMENT: AVOID high-purine foods—organ meats (liver, kidney), red meat, shellfish, sardines, anchovies, alcohol, high-fructose drinks
- DIET ENCOURAGE: Increase fluid intake 2–3 L/day to prevent urate stone formation; maintain healthy weight (avoid crash dieting—raises uric acid)
- ACUTE ATTACK DRUGS: Colchicine (watch for nausea, vomiting, diarrhea—signs of toxicity), NSAIDs, corticosteroids
- CHRONIC URATE-LOWERING: Allopurinol (xanthine oxidase inhibitor reduces urate production), probenecid (increases urate excretion)
- CRITICAL: DO NOT START ALLOPURINOL DURING ACUTE ATTACK—may worsen it; start 2–4 weeks after attack resolves
- AVOID ASPIRIN: Raises serum uric acid and may precipitate attacks
- ACUTE MANAGEMENT NURSING: Rest, elevate, immobilize joint, cold application, bed cradle to protect from linens weight, pain management
Key Definitions
Term
Gout
Example
Sudden red, hot, swollen, exquisitely tender great toe (podagra)
Definition
Metabolic arthritis caused by monosodium urate crystal deposition in joints, triggered by hyperuricemia.
Term
Hyperuricemia
Example
Caused by overproduction or underexcretion of uric acid
Definition
Elevated serum uric acid (>6.8 mg/dL), the underlying metabolic defect in gout.
Term
Tophi
Example
May lead to deformity and joint destruction if untreated
Definition
Deposits of monosodium urate crystals in chronic gout, forming nodules on ear, fingers, and other sites.
Diagrams To Know
- Gout acute attack vs chronic management timeline
- Purine metabolism and urate formation pathway
Common Values
Value
>−1
Symbol
Normal bone
Quantity
DEXA T-score (normal)
Value
−1 to −2.5
Symbol
Precursor state
Quantity
DEXA T-score (osteopenia)
Value
≤−2.5
Symbol
Established disease
Quantity
DEXA T-score (osteoporosis)
Section Title
Osteoporosis — Bone Loss & Prevention
Important Facts
- OSTEOPOROSIS: Often silent until fracture occurs—hip, vertebral (compression fractures), wrist (Colles fracture)
- RISK FACTORS: Postmenopausal estrogen loss, advanced age, female sex, small thin frame, low calcium/vitamin D, sedentary lifestyle, smoking, excess alcohol, long-term corticosteroid use (most important modifiable)
- DIAGNOSIS: DEXA T-score ≤ −2.5 indicates osteoporosis; −1 to −2.5 = osteopenia (precursor state)
- CALCIUM INTAKE: 1000–1200 mg/day (dietary: milk, cheese, yogurt, leafy greens, fortified foods; supplements if intake inadequate)
- VITAMIN D INTAKE: 800–1000 IU/day (exposure to sunlight, fatty fish, egg yolks, fortified milk, supplements)
- EXERCISE: Weight-bearing exercise (walking, jogging) stimulates bone formation; strength training and balance improve fracture prevention
- BISPHOSPHONATES (alendronate, risedronate): Inhibit osteoclast-mediated bone resorption; slow bone loss and reduce fracture risk
- BISPHOSPHONATE TEACHING: Take on EMPTY STOMACH in morning with FULL GLASS OF PLAIN WATER; REMAIN UPRIGHT (sitting/standing) for ≥30 min to prevent esophagitis/erosion; may cause jaw osteonecrosis (rare)
- HORMONE REPLACEMENT THERAPY: May prevent bone loss in postmenopausal women, but cardiac/thromboembolism risks limit use
- FALL PREVENTION: Remove hazards, adequate lighting, assistive devices, vision/hearing checks—fracture is feared outcome
Key Definitions
Term
Osteoporosis
Example
Postmenopausal woman with DEXA T-score ≤ −2.5
Definition
Metabolic bone disease with low bone mass and deteriorated bone microarchitecture, leading to increased fragility and fracture risk.
Term
DEXA Scan
Example
T-score ≤ −2.5 = osteoporosis; −1 to −2.5 = osteopenia
Definition
Dual-energy X-ray absorptiometry; gold-standard diagnostic imaging for bone mineral density.
Term
Dowager's Hump
Example
Progressive forward curvature of upper back with height loss
Definition
Kyphosis of thoracic spine from vertebral compression fractures in osteoporosis.
Diagrams To Know
- Bone remodeling cycle and effect of bisphosphonates
- Risk factors and prevention strategies flowchart
Section Title
Osteomyelitis — Bone Infection & IV Antibiotic Therapy
Important Facts
- OSTEOMYELITIS ETIOLOGY: Hematogenous spread (most common), adjacent soft tissue infection, direct inoculation (open fracture, surgery)
- CAUSATIVE ORGANISM: Staphylococcus aureus (80%–90%); also Streptococcus, Gram-negative rods, anaerobes
- CLINICAL PRESENTATION: Bone pain, fever, chills, swelling, warmth, erythema over affected bone; if chronic, may have draining sinus tract
- DIAGNOSIS: Blood cultures (positive in early hematogenous disease), elevated WBC/ESR/CRP, imaging (X-ray, MRI, bone scan), bone biopsy for culture/sensitivity
- TREATMENT: Prolonged IV antibiotics (4–6 weeks minimum, often 6–12 weeks) based on culture sensitivity; surgical debridement of dead bone (sequestrum) if needed; prolonged immobilization
- ANTIBIOTIC SELECTION: Empiric broad-spectrum until culture/sensitivity available (e.g., nafcillin or oxacillin for S. aureus); switch to organism-specific therapy
- NURSING CARE: Immobilize and elevate affected limb (prevent pathologic fracture), manage pain, maintain IV access (often central line for prolonged therapy), aseptic wound care, monitor for antibiotic side effects
- NUTRITION: Protein and vitamin C to support bone healing; monitor for malnutrition with chronic infection
- PSYCHOSOCIAL: Extended illness (months) requires coping support, education on IV antibiotic home therapy (often PICC line or Port), adherence to long-term follow-up
- COMPLICATION: Pathologic fracture (weakened bone prone to breaking), chronic osteomyelitis with recurrent flares, sepsis if untreated
Key Definitions
Term
Osteomyelitis
Example
Post-surgical infection after open fracture fixation with fever, bone pain, swelling
Definition
Acute or chronic infection of bone, usually bacterial (Staphylococcus aureus most common), with inflammatory response and bone destruction.
Term
Sequestrum
Example
Seen on imaging as separated fragment of dead bone
Definition
Dead bone fragment isolated during osteomyelitis infection; often requires surgical removal.
Diagrams To Know
- Osteomyelitis pathogenesis: entry routes and inflammatory cascade
- IV antibiotic management timeline and nursing monitoring
Section Title
Total Hip Replacement (THR) — Hip Precautions & Dislocation Prevention
Important Facts
- HIP PRECAUTIONS RULE 1—NO HIP FLEXION >90°: Avoid low chairs, low toilets, bending forward, tying shoes, putting on pants; use raised toilet seats, long-handled reacher, sock aid, shoe horn
- HIP PRECAUTIONS RULE 2—NO LEG ADDUCTION PAST MIDLINE: Keep abduction pillow between legs at all times (sitting, lying); NEVER cross legs; keep legs apart
- HIP PRECAUTIONS RULE 3—NO INTERNAL ROTATION: Keep toes pointing forward/upward; avoid inward-facing feet or pigeon-toe position
- TURNING IN BED: Turn only as ordered (usually onto unaffected side); keep abduction pillow between legs; log-roll to maintain hip alignment if needed
- DISLOCATION SIGNS (REPORT IMMEDIATELY): Sudden severe hip pain, leg shortened and internally or externally rotated, inability to move or bear weight, audible/palpable 'pop'
- POSTOPERATIVE CARE: DVT/PE prevention (anticoagulants, compression devices, early mobilization), wound care (monitor drain, signs of infection), pain management, quad/glute setting exercises, isometric abduction
- PHYSICAL THERAPY: Early PT (usually POD1–2); progressive weight-bearing as tolerated, walker/crutches initially, then cane; ambulation on level surfaces first
- TOTAL KNEE REPLACEMENT (TKR): Similar principles; CPM (continuous passive motion) machine often used to maintain ROM; emphasis on knee extension and flexion exercises
- ACTIVITY RESTRICTIONS: No driving until cleared by surgeon (usually 6 weeks); return to ADLs gradually; avoid high-impact activities (jogging, jumping)
- LONG-TERM OUTCOMES: Most patients achieve pain relief and improved function; longevity of prosthesis 15–20+ years; may need revision later
Key Definitions
Term
Hip Precautions
Example
No crossing legs, no hip flexion >90°, maintain abduction pillow between legs
Definition
Strict movement restrictions after total hip replacement to prevent prosthetic dislocation by limiting hip flexion, adduction, and internal rotation.
Term
Hip Dislocation (Prosthetic)
Example
Patient reports sudden sharp hip pain and leg appears shorter and inward-rotated
Definition
Femoral head slides out of acetabular socket; most common early complication after THR, presenting with severe pain, shortened/rotated leg, and inability to bear weight.
Diagrams To Know
- Hip precautions visual guide with prohibited and allowed positions
- Post-THR progression pathway from acute care to home discharge
Section Title
Low Back Pain — Mechanical Causes, Red Flags, & Nursing Interventions
Important Facts
- LOW BACK PAIN EPIDEMIOLOGY: Most common after age 30; mechanical causes in 90%, serious pathology in <5% (cancer, infection, fracture, cauda equina)
- MECHANICAL CAUSES: Muscle strain, degenerative disc disease, facet joint osteoarthritis, disc herniation, spondylolisthesis
- ACUTE MANAGEMENT: Activity modification (avoid bed rest >1–2 days), NSAIDs, muscle relaxants (cyclobenzaprine), heat or cold, PT/exercises
- BODY MECHANICS TEACHING: Bend at KNEES not waist, keep objects close to body when lifting, avoid twisting motions, maintain good posture, sleep on firm mattress, strengthen core muscles, maintain healthy weight
- CORE STRENGTHENING: Pelvic tilts, bridges, dead bugs, planks, bird dogs—essential for long-term back stability
- RED-FLAG FINDINGS (URGENT EVALUATION NEEDED): New onset bowel/bladder incontinence, saddle anesthesia (perineal/buttock/inner thigh), progressive bilateral leg weakness, severe night pain unrelieved by position, fever with back pain, unintentional weight loss, hx of cancer
- CAUDA EQUINA SYNDROME: SURGICAL EMERGENCY—requires immediate MRI and neurosurgical consultation; decompressive laminectomy indicated
- IMAGING: Plain X-rays for suspected fracture; MRI for suspected disc herniation or serious pathology; CT/myelography if MRI contraindicated
- HERNIATED DISC CONSERVATIVE CARE: NSAIDs, muscle relaxants, PT, epidural steroid injection may be tried before surgery
- SURGICAL INDICATIONS: Persistent radiculopathy (4–6 weeks conservative), neurologic deficit progression, cauda equina syndrome
- POST-SPINAL SURGERY CARE: Log-roll technique to keep spine aligned, monitor for CSF leak (clear drainage on dressing—notify surgeon immediately), assess for new neurologic deficits, activity restrictions as ordered, pain management
Key Definitions
Term
Low Back Pain (Mechanical)
Example
Construction worker with acute lumbar strain after heavy lifting
Definition
Pain due to musculoskeletal causes (muscle strain, degenerative disc disease, facet joint disease) without neurologic compromise.
Term
Herniated Intervertebral Disc
Example
L4–L5 disc herniation causing right leg pain, numbness, weakness radiating to foot
Definition
Nucleus pulposus protrusion through anulus fibrosus, potentially compressing nerve root and causing radiculopathy (sciatica).
Term
Sciatica
Example
Sharp, burning leg pain with numbness and weakness in L5 or S1 distribution
Definition
Radiating leg pain caused by sciatic nerve root compression, often from disc herniation; pain travels from buttock to foot.
Term
Cauda Equina Syndrome
Example
Loss of bowel/bladder control with severe bilateral leg pain—EMERGENCY
Definition
Surgical emergency: compression of multiple nerve roots in lumbosacral spine causing bowel/bladder incontinence, saddle anesthesia, bilateral leg weakness.
Diagrams To Know
- Spinal nerve anatomy and disc herniation compression sites
- Red-flag assessment flowchart for urgent vs routine back pain
- Log-rolling technique and proper postoperative positioning
Section Title
Nursing Diagnoses & Pathophysiology Links
Important Facts
- Pain Management in Arthritis: Maslow priority—address pain before mobility/self-care; use pharmacologic (analgesics, NSAIDs, DMARDs) + non-pharmacologic (rest, heat/cold, elevation, positioning)
- Mobility Issues Post-THR: Impaired mobility related to surgical trauma and precautions; nursing interventions include PT supervision, assistive devices, safety measures, gradual progression
- Infection Risk (Post-surgical & Chronic Infection): Monitor wound for signs (warmth, erythema, drainage, fever); maintain asepsis; screen for systemic signs (fever, elevated WBC); teach infection precautions (especially biologic DMARD users)
- Long-term Compliance: Critical nursing diagnosis for gout (diet adherence), osteoporosis (calcium/vitamin D, bisphosphonate adherence), RA (DMARD adherence); educate on consequences of non-compliance
- Psychosocial Support: Chronic arthritis, prolonged IV therapy, lifestyle restrictions (hip precautions) impact self-esteem and mental health; refer for counseling, support groups
- Activity Intolerance: RA/OA with pain and deformity may limit activity; balance rest and activity per NCM protocols; encourage joint protection and energy conservation
- Self-Care Deficit: Advanced arthritis, post-surgical limitations, age-related decline may impair ADL independence; assess and provide adaptive equipment, caregiver training
Key Definitions
Term
NANDA Diagnosis: Acute Pain
Example
AEB severely swollen, red great toe with client guarding and grimacing
Definition
Unpleasant sensory experience related to inflammatory or tissue-damaging process (e.g., acute gout attack, post-THR).
Term
NANDA Diagnosis: Impaired Physical Mobility
Example
AEB inability to bear weight, use of assistive device, restricted ROM
Definition
Limitation in independent movement due to musculoskeletal damage, pain, or imposed restrictions (e.g., hip precautions post-THR).
Term
NANDA Diagnosis: Risk for Infection
Example
Related to surgical incision, biologic DMARD use increasing infection risk
Definition
Increased vulnerability to pathogenic organisms, especially after surgical procedures or with compromised immune response (e.g., post-THR, long-term DMARDs).
Term
NANDA Diagnosis: Deficient Knowledge
Example
AEB client unable to list high-purine foods or demonstrate proper bisphosphonate technique
Definition
Lack of understanding about disease management, medication, or self-care (e.g., gout diet, bisphosphonate administration, hip precautions).
Diagrams To Know
- NANDA-I diagnostic tree for musculoskeletal disorders
- Nursing process applied to post-THR care
Must Remember
- OA = Degenerative, asymmetric, weight-bearing joints, Heberden's/Bouchard's nodes, stiffness <30 min, NO systemic signs. RA = Autoimmune, symmetric, small joints, morning stiffness >1 hour, systemic signs, positive RF/anti-CCP.
- OA first-line drug is ACETAMINOPHEN. RA anchor DMARD is METHOTREXATE—give FOLIC ACID, monitor liver/marrow, TERATOGENIC.
- GOUT: Avoid HIGH-PURINE foods (organ meats, shellfish, alcohol). Use COLCHICINE + NSAIDs for ACUTE flare. Use ALLOPURINOL for LONG-TERM prevention—NEVER start during acute attack. Push fluids 2–3 L/day.
- BISPHOSPHONATES (osteoporosis): Take on EMPTY STOMACH, full glass plain WATER, STAY UPRIGHT ≥30 minutes to prevent esophagitis.
- TOTAL HIP PRECAUTIONS: NO hip flexion >90°, NO leg adduction past midline (use abduction pillow, don't cross legs), NO internal rotation. Report shortened, rotated leg immediately (dislocation).
- OSTEOMYELITIS: Usually Staph aureus. Treat with PROLONGED IV ANTIBIOTICS (4–6+ weeks). Handle limb gently (pathologic fracture risk). Debride dead bone (sequestrum) if needed.
- LOW BACK PAIN RED FLAGS: Bowel/bladder incontinence, saddle anesthesia, bilateral leg weakness, progressive neurologic deficit—consider CAUDA EQUINA SYNDROME (SURGICAL EMERGENCY).
- BODY MECHANICS for back pain: Bend at KNEES not waist, keep objects close, avoid twisting, firm mattress, core strengthening. Log-roll post-spinal surgery to maintain alignment.
- RA BIOLOGICS (etanercept): Increase infection risk; screen for TB before use; monitor for signs of infection. Short-course CORTICOSTEROIDS control inflammation but taper to prevent rebound.
- Post-THR complications: Watch for DVT/PE (anticoagulation, compression devices), infection (aseptic wound care), dislocation (hip precautions). Weight-bearing progresses as tolerated; walker/crutches initially, then cane.
Last Minute Tips
- **OA vs RA distinction is exam gold**: Memorize the asymmetric/symmetric, weight-bearing/small joints, brief/prolonged stiffness, no systemic/systemic distinctions. One quick comparison question can earn 3–5 points.
- **Hip precautions are procedural**: Examiners test your ability to teach or demonstrate. Know the 3 rules cold (no flexion >90°, no adduction past midline, no internal rotation) and be ready with specific examples of what's safe vs unsafe (e.g., 'raised toilet seat' vs 'low chair').
- **Gout diet is high-yield**: High-purine foods (organ meats, shellfish, sardines, anchovies, alcohol especially beer) appear on almost every exam. Also know fluids prevent stones, allopurinol is NOT for acute attacks, and aspirin raises uric acid.
- **Bisphosphonate administration is step-by-step nursing care**: Empty stomach, full water glass, upright 30 min—test questions ask what you'll teach the patient. Also know esophagitis risk and jaw osteonecrosis (rare but asked).
- **Cauda equina syndrome is your emergency trigger**: Bowel/bladder incontinence + saddle anesthesia + bilateral leg weakness = STAT MRI + neurosurgery consult. This is one of the few musculoskeletal emergencies on the NLE and appears reliably.
Comparison Tables
Rows
Values
- Degenerative, wear-and-tear cartilage loss
- Autoimmune, inflammatory synovitis with pannus formation
Property
Pathophysiology
Values
- Asymmetric (unilateral or one side worse)
- Symmetric (bilateral, equal both sides)
Property
Symmetry
Values
- Weight-bearing (knees, hips, spine) + DIP fingers
- Small joints first (hands, wrists, feet, MCPs, PIPs)
Property
Joints Affected
Values
- Gradual, progressive over years
- Insidious or acute, progresses in flares
Property
Onset & Progression
Values
- <30 minutes, improves with activity
- >1 hour (often 2–3 hours), improves slowly
Property
Morning Stiffness
Values
- Worse with activity, relieved by rest
- Worse in morning, improves with activity initially
Property
Pain Pattern
Values
- ABSENT (no fever, fatigue, weight loss)
- PRESENT (fatigue, low-grade fever, weight loss, malaise)
Property
Systemic Signs
Values
- Heberden's nodes (DIP), Bouchard's nodes (PIP)
- Ulnar deviation, swan-neck, boutonnière deformities
Property
Hand Signs
Values
- Normal or only slightly elevated
- Elevated (markedly in active disease)
Property
ESR & CRP
Values
- Negative
- Positive (70–80%); negative in seronegative RA
Property
Rheumatoid Factor (RF)
Values
- Negative
- Positive (more specific than RF)
Property
Anti-CCP
Values
- Acetaminophen
- NSAIDs + DMARDs (methotrexate anchor)
Property
First-Line Drug
Values
- Usually >50 years
- Usually 30–60 years (peak 40–60)
Property
Age of Onset
Values
- Equal M:F after age 50
- Female predominance (3:1)
Property
Sex Predominance
Values
- Joint space narrowing, osteophytes, sclerosis
- Periarticular soft tissue swelling, joint space narrowing, erosions
Property
X-Ray Findings
Columns
- Feature
- Osteoarthritis (OA)
- Rheumatoid Arthritis (RA)
Table Title
Osteoarthritis (OA) vs Rheumatoid Arthritis (RA) — COMPREHENSIVE COMPARISON
Rows
Values
- During flare (days to weeks)
- Between attacks (ongoing)
Property
Timing
Values
- Reduce inflammation, relieve pain, terminate attack
- Lower serum uric acid, prevent recurrent attacks, reduce tophi
Property
Primary Goals
Values
- Colchicine, NSAIDs, corticosteroids
- Allopurinol, probenecid
Property
Drugs Used
Values
- Strict rest of joint, no purine avoidance urgency
- Sustained avoidance of high-purine foods, maintain hydration
Property
Dietary Focus
Values
- Maintain hydration to dilute urate
- 2–3 L/day to prevent stone formation and maintain urate solubility
Property
Fluids
Values
- Primary agent for acute inflammation
- Low-dose prophylaxis may be used to prevent attacks
Property
Colchicine Role
Values
- CONTRAINDICATED during acute attack—may worsen
- Start 2–4 weeks after attack resolves; reduces urate production
Property
Allopurinol Role
Values
- Avoid (raises uric acid)
- Avoid (raises uric acid); low-dose may be considered only after attack resolved
Property
Aspirin
Columns
- Aspect
- Acute Attack
- Chronic Prevention
Table Title
Gout: Acute Attack Management vs Long-Term Prevention
Rows
Values
- >−1
- Normal bone density
- Low
Property
Normal
Values
- −1 to −2.5
- Low bone mass (precursor state)
- Intermediate
Property
Osteopenia
Values
- ≤−2.5
- Low bone mass with deteriorated structure
- High
Property
Osteoporosis
Values
- ≤−2.5 + prior fragility fracture
- Established disease with fracture history
- Very High
Property
Severe Osteoporosis
Columns
- Classification
- DEXA T-Score
- Bone Status
- Fracture Risk
Table Title
Osteoporosis vs Osteopenia vs Normal Bone — DEXA T-Score Classification
Rows
Values
- Keep hip <90°: use raised toilet seat, raised chair, long reacher, sock aid
- Flex hip >90°: avoid low chair, bending forward, tying shoes, crossing legs
Property
Hip Flexion
Values
- Keep abduction pillow between legs at ALL times; keep legs apart
- Adduct leg past midline or cross legs (high dislocation risk)
Property
Leg Adduction
Values
- Keep toes pointing forward/upward
- Internally rotate (pigeon-toe) or externally rotate excessively
Property
Rotation
Values
- Turn as ordered (usually unaffected side) with pillow between legs
- Roll without maintaining alignment; cross legs during turn
Property
Turning in Bed
Values
- Move slowly, maintain alignment, use assistive devices
- Quick, jerky movements without protection
Property
Position Changes
Columns
- Hip Precaution Rule
- DO
- DON'T
Table Title
Total Hip Replacement: DO's and DON'Ts at a Glance
Rows
Values
- Localized to low back, lumbar region
- Radiating leg pain (sciatica) below knee, follows nerve distribution
Property
Pain Location
Values
- Muscle tightness, limited ROM, worse with activity
- Numbness, tingling, weakness in leg; may have foot drop
Property
Associated Symptoms
Values
- Normal strength, sensation, reflexes
- Weakness, sensory loss, diminished/absent reflex (radiculopathy pattern)
Property
Neurologic Findings
Values
- Usually normal or limited by pain but without neural tension
- Positive (pain radiates down leg; reproduces sciatica)
Property
Straight Leg Raise (SLR) Test
Values
- Normal or shows degenerative changes
- May show disc space narrowing or bulge
Property
Imaging (X-ray)
Values
- Normal or minor degenerative changes
- Shows disc herniation, nerve root compression
Property
Imaging (MRI)
Values
- Activity modification, NSAIDs, PT, core strengthening
- NSAIDs, PT, epidural steroid injection, activity modification
Property
Conservative Treatment
Values
- Rare; only if intractable pain unresponsive to prolonged conservative care
- Persistent/progressive symptoms (4–6 weeks), neurologic deficit, surgical emergency if cauda equina
Property
Surgical Indication
Columns
- Feature
- Mechanical Back Pain
- Herniated Disc (Radiculopathy)
Table Title
Herniated Disc vs Mechanical Low Back Pain — Clinical Distinction
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