Rheumatology

Question 1

Describe osteoarthritis.

Answer 1

It is a non-inflammatory, degenerative condition of the joints, which is characterized by degeneration of articular cartilage and formation of new bones. It is also characterized by metabolic, biochemical and structural changes in the articular cartilage and surrounding tissues that leads to structural failure and ulceration of the load bearing articular surface.

Question 2

Describe some of the factors that contributes to osteoarthritis.

Answer 2

Joint integrity.
Genetic predisposition.
Local inflammation.
Mechanical forces.
Cellular and biochemical processes.

Question 3

What are some of the risk factors osteoarthritis?

Answer 3

Obesity.
Abnormal mechanical loading.
Inherited type 2 collagen defects in premature polyarticular OA.
Inheritance in Nodal OA.
Occupation.
Infection.
Poor posture.
Aging process in joint cartilage.
Defective lubricating mechanisms. 
Incomplete treated congenital dislocation of the hips.

Question 4

What are the two classifications of OA?

Answer 4

Primary (unknown cause, in elderly, wear and tear, localized or generalized).
Secondary (predisposing causes)

Question 5

What are the types of OA?

Answer 5

Nodal generalized OA.
Crystal associated OA.
OA of premature onset.

Question 6

What are some of the symptoms of OA?

Answer 6

Localized joint pain. Weight bearing joints may lock or give way.
Stiffness in the morning or following inactivity rarely exceeds 30 minutes.
Pain is worse at the end of the day.

Question 7

What are the signs of OA?

Answer 7

Bony enlargements.
Crepitus.
Cool effusions.
Decreased range of motion.
Tenderness on palpation at the joint line.
Pain in passive motion.
Absent in OA is the boggy synovitis in inflammatory arthritis.
Distribution-more weight bearing joints but can involve the hands.

Question 8

What are the clinical features of OA?

Answer 8

Pain.
Stiffness.
Muscle spasm.
Restricted movement.
Deformity.
Muscle weakness r wasting.
Joint enlargement and instability.
Crepitus.
Joint effusion.

Question 9

Provide some of the causes of pain in OA.

Answer 9

Raised intra-osseous pressure. 
Inflammatory synovitis.
Periosteal elevation.
Muscular changes.
Fibromyalgia/pain amplification.
Central neurogenic changes. 
Coarse crepitus.

Question 10

What laboratory tests would be performed in order to diagnose OA?

Answer 10

ESR (erythrocyte sedimentation rate)
Rheumatoid factor titers.
Evaluation of synovial fluid.
Radiographic study of affected joints.

Question 11

What are some of the radiological features of OA?

Answer 11

Osteophyte formation.
Joint space narrowing.
Subchondral sclerosis.
Cysts.
Bouchards nodes.
Heberden's nodes.

Question 12

How would you manage OA?

Answer 12

Education.
Relieve the symptoms, control the pain and swelling.
Minimize handicap.
Limit progression and prevent disabilities.

Question 13

Wat are some of the surgical management options for OA?

Answer 13

Arthroscopic washout.
Joint debridement.
Bony decompression.
Osteotomy.
Arthroplasty.
Joint replacement.

Question 14

What are some of the medical managements for OA?

Answer 14

Analgestics, low dose paracetamol, low dose ibuprofen. 
NSAIDs
Intra-articular corticosteriods.
Tropical treatments
Chondroprotective agents.

Question 15

What are some of the characteristics of rheumatic arthritis?

Answer 15

It is chronic, systemic, an auto-immune disorder and causes a symmetrical polyarthritis.
It is a chronic inflammatory disorder that mainly attacks the joints which produce an inflammatory synovitis. The pain intensity and deterioration of joint structures progress over time and often lead to deformations and disability.

Question 16

What other affects can rheumatoid arthritis have on the body?

Answer 16

It can cause inflammation in the lungs, pericardium, pleura and sclera.

Question 17

Define synovitis.

Answer 17

The thickening of the synovial lining.

Question 18

Describe the pathology of synovitis.

Answer 18

Infiltration by inflammatory cells.
Generation of new synovial blood vessels is induced by angiogenic cytokines.
Activated endothelial cells produce adhesion molecules. The expediate extravasation of leucocytes into the synovium. The synovium proliferates and grows out over the cartilage.
It produces a tumor like mass=pannus. The pannus destroys the cartilage and subchondral bone producing bony erosions.

Question 19

What are some of the clinical features of RA?

Answer 19

The onset of pain.
Early morning stiffness (>30 min).
Swelling on the small joints of the hands and feet. Weakening of the joint capsule (joint instability, subluxation, deformity).

Question 20

What are some of the signs and symptoms of RA?

Answer 20

Arthritis of joints-synovitis.
Joints become swollen, tender, warm and stiffness occurs. Multiple joints affected (small joint-hands, feet, cervical spine; large joints-.