Skeletal & Cartilaginous Tissue Disease Cards

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Metabolic Bone Diseases

Metabolic
Osteoporosis

Weak, porous bones

What is it?

Bones become weak and full of holes because they lose density over time. Like a sponge squeezed dry - brittle and breaks easily.

Who gets it?

  • Women after menopause (estrogen loss)
  • Older adults (both sexes over 70)
  • People on long-term steroids

Signs & Symptoms:

  • Usually NO symptoms until fracture
  • Breaks from minor falls
  • Most common: hip, spine, wrist
  • Loss of height, stooped posture

Treatment:

  • Bisphosphonates (Fosamax)
  • Calcium 1200 mg + Vitamin D daily
  • Weight-bearing exercise
LPN Alert: Bisphosphonates taken on empty stomach, sitting upright 30 min after
Metabolic
Rickets / Osteomalacia

Soft bones (vitamin D deficiency)

What is it?

Bones are too soft - not enough calcium/phosphate minerals. Like concrete without cement. Rickets = children; Osteomalacia = adults.

Main Cause:

Not enough Vitamin D - needed to absorb calcium from food

Signs (Children):

  • Bowed legs or knock-knees
  • Short height, slow growth
  • Bone pain, muscle weakness

Signs (Adults):

  • Bone pain with walking
  • Muscle weakness (stairs, chairs)
  • Waddling walk

Treatment:

  • High-dose vitamin D supplements
  • Calcium 1000-1500 mg daily
  • Sun exposure 10-15 min daily
Good News: Symptoms improve within weeks!
Metabolic
Paget's Disease

Disorganized bone remodeling

What is it?

Bones break down and rebuild too fast. New bone is disorganized and weak - bigger but weaker. Like building a house too quickly.

Who gets it?

  • Rare before age 40
  • Most common over age 55
  • Can run in families

Signs & Symptoms:

  • Often NO symptoms (found by accident)
  • Bone pain - deep, aching, worse at night
  • Bowed legs, larger skull (hat doesn't fit)
  • Hearing loss if skull affected
  • Affected bones feel warm

Diagnosis:

Very high alkaline phosphatase (10-25x normal)

Treatment:

  • Bisphosphonates (usually single IV dose)
  • Calcium + vitamin D supplements
LPN Alert: Flu-like symptoms normal 1-3 days after IV bisphosphonate

Inflammatory Joint Diseases

Inflammatory
Osteoarthritis (OA)

"Wear and tear" arthritis

What is it?

Cartilage cushion wears away over time. Bones rub together causing pain. Like brake pads wearing down.

Who gets it?

  • Older adults (over 50)
  • Overweight people
  • Athletes or joint injuries

Signs & Symptoms:

  • Pain worse with activity, better with rest
  • Morning stiffness <30 minutes
  • Grinding/cracking in joints
  • Bony bumps on fingers
  • NO fever or fatigue

Most affected:

Knees, hips, hands, spine

Treatment:

  • Weight loss if overweight
  • Exercise (swimming, walking)
  • Acetaminophen, NSAIDs
  • Joint replacement for severe cases
LPN Alert: NSAIDs can cause stomach bleeding - give with food
Inflammatory
Rheumatoid Arthritis (RA)

Autoimmune arthritis

What is it?

Immune system attacks joint lining - inflammation and joint destruction.

Who gets it?

  • Women 3x more than men
  • Ages 40-60
  • Can run in families

Key Features:

  • Affects BOTH sides equally (both hands, both knees)
  • Morning stiffness >1 hour
  • Small joints first (fingers, wrists, toes)
  • Fatigue, low-grade fever
  • Late: joint deformities

Diagnosis:

  • RF and anti-CCP antibodies
  • Elevated ESR, CRP

Treatment:

  • Methotrexate (start early!)
  • Biologic drugs (Humira, Enbrel)
  • Steroids for flares
LPN Alert: These meds suppress immune system - watch for infection signs
Inflammatory
Psoriatic Arthritis

Skin + joint disease

What is it?

Inflammatory arthritis in people with psoriasis (red, scaly skin patches). Immune system attacks skin AND joints.

Who gets it?

  • 30% of psoriasis patients
  • Ages 30-50
  • Skin symptoms usually come first

Classic Signs:

  • "Sausage" fingers/toes (entire digit swollen)
  • Red, scaly skin patches
  • Pitted, discolored nails
  • Heel/foot pain
  • Lower back pain (spine involvement)

Different from RA:

  • Has skin psoriasis
  • Affects fingertip joints (RA doesn't)
  • RF/anti-CCP usually negative

Treatment:

  • Methotrexate (skin + joints)
  • Biologics (very effective)
  • NSAIDs for pain
LPN Alert: Screen for TB before starting biologics

Crystal Arthropathies

Crystal Disease
Gout

Uric acid crystals in joints

What is it?

Uric acid crystals build up in joints causing sudden, severe pain. Like broken glass inside a joint.

Who gets it?

  • Men 9x more than women
  • Over age 40
  • Red meat, seafood, beer drinkers
  • People on diuretics ("water pills")

Acute Attack:

  • Sudden, severe pain (wakes you up)
  • Usually starts in big toe
  • Joint red, hot, swollen, tender
  • Can't even touch it!
  • Peaks in 12-24 hours

Between attacks:

No symptoms at all

Treatment (Acute):

  • High-dose NSAIDs (start immediately!)
  • Colchicine (best within 24 hours)

Prevention:

  • Allopurinol (lowers uric acid)
  • Limit red meat, shellfish, alcohol
  • Drink lots of water
LPN Alert: Gout can look like infection - joint may need testing

Bone Tumors

Bone Tumor
Osteosarcoma

Bone cancer in teens

What is it?

Bone cancer that affects teenagers. Malignant cells produce abnormal bone. Grows fast, can spread to lungs.

Who gets it?

  • Teenagers (ages 10-20)
  • During growth spurts
  • Usually near the knee

Signs & Symptoms:

  • Bone pain worse at night (NOT growing pains!)
  • Pain gets worse over time
  • Swelling or lump over bone
  • Limping if in leg
  • Bone may break

Diagnosis:

  • X-ray: "sunburst" pattern
  • MRI: shows tumor size
  • CT chest: check lungs
  • Biopsy: confirm cancer

Treatment:

  • Chemo BEFORE surgery (10-12 weeks)
  • Surgery: Remove tumor (90% limb-sparing)
  • Chemo AFTER surgery (6-12 months)
Important: With treatment, 60-70% are cured!

Nutritional Deficiencies

Nutritional
Scurvy

Vitamin C deficiency

What is it?

Not enough vitamin C. Vitamin C is needed to make collagen (the "glue" holding body together). Blood vessels break easily, bones weak.

Who gets it?

Rare today, but seen in:

  • Elderly who don't eat fruits/veggies
  • Alcoholics
  • Food-insecure individuals

Signs (takes 3+ months):

  • Easy bruising
  • Bleeding, swollen gums
  • Loose teeth
  • Corkscrew hairs with red dots
  • Bone and joint pain
  • Wounds don't heal

Treatment:

  • Vitamin C: 300 mg three times daily for 1 week
  • Then 100 mg daily maintenance
  • Eat: oranges, strawberries, bell peppers, broccoli
Amazing Recovery: Patients feel better in 24-48 hours! Complete recovery in 3 months.