26. Osteoarthritis and rheumatoid arthritis Flashcards Preview

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Flashcards in 26. Osteoarthritis and rheumatoid arthritis Deck (47)
1

etiology of osteoarthritis

mechanical - joint wear and tear destroys of articular cartilage

2

etiology of Rheumatoid arthritis

autoimmune - infl cytokines and cells induce pannus ( proliferation tissue ) formation --> erodes articular cartilage and bone

3

osteathritis is also called

degenative joint disease

4

Rheumatoid athritis - autoimmun destruction is mediated by

cytokine and II and IV hypersensitivity reactions

5

eburnations are

polished, ivory like appearance of the body

6

osteoarhritis of the hand - which joints

- DIP ( Heberden nodes )
- PIP ( Bouchard nodes )
- 1st carpometacarpal ( CMC)
NO MCP

7

swan neck deformity

DIP hyperflexion with PIP hyperextension

8

boutonniere deformity

PIP flexion with DIP hyperextension

9

predisposing factors of osteoarthritis

1. age
2. obesity
3. joint trauma
4. female

10

predisposing factor of Rheumatoid arthritis

1. female ( 80% vs males )
2. + Rheumatoid factor
3. Anti-cyclic citrullinated peptide antibody ( more specific )
4. HLA- DR4
5. SILICA exposure

11

Rheumatoid arhtritis - HLA

HLA - DR4

12

predisposing dacroe of rheumatoid arthritis - more specific

anti- cyclic citrullinated peptide antibody

13

Rheumatoid factor ?

IgM against IgG antibody

14

osteoarthritis - classic presentation

pain in weight - bearing joint after use ( at the end of the day ), improving at rest .
Asymmetric joint involvement
Knee cartilage loss begins medially ( bowlegged )
Non- inflammatory. No systemic symptoms

15

rheumatoid arthritis - classic presentation

Morning stiffness, pain and swelling lasting more than 30 mins and improving with use symmetric joint involvemnt . Systemic symptoms

16

systemic symptoms of Rheumatoid arthritis

1. fever
2. weight loss
3. lymphadenopathy

17

osteoarthritis - joints

limited number of joints ( oligoarticulopathy )
1. hips
2. lower lumbar spine
3. knees
4. DIP
5. PIP

18

herbeden nodes - area

DIP

19

Bouchard nodes - area

PIP

20

Rheumatoid arhritis - joints

symmetric involvement
1. PIP
2. MCP
3. Elbows
4. Knee
5. ankles

21

Rheumatoid arthritis can cause ... in the knee

Baker cyst

22

Rheumatoid arthritis - treatment

1. NSAID
2. glucocorticoids
3. disease - modifying against ( methotrexate, sulfasalazine, hydroxychlotoquine, leflunamide )
4. biologics ( TNF -a inhibitors )

23

osteoarhtritis - treatment

1. acetaminophen
2. NSAID
3. intra-articular glucorticoids

24

Rheumatoid arthritis vs osteoarthritis - according to joint involvem
ent distribution

RA --> symmetrical
Osteoarthritis --> asymmetrical

25

RA vs osteoathritis - MCP

RA

26

RA vs osteoathritis - DIP

osteoarhritis ( heberden )
rare in RA

27

Rheumatoi athritis - x-rays

joint - space narrowing loss of cartila
osteopenia ge

28

RA vs osteoathritis- increased synovial fluid / wbc ?

RA --> increased fluid
WBC --> less than 2000 in osteoarthrits, more in RA

29

• Systemic symptoms like fever/malaise are ___ (present/absent) in osteoarthritis, which is a/an ___ (inflammatory/noninflammatory) arthritis.

Absent (osteoarthritis is not associated with systemic symptoms), noninflammatory

30

• Why is the presentation of osteoarthritis sometimes described as bowleggedness?

Because cartilage loss typically begins at the medial aspect of the knees

31

• Is eburnation (a polished, ivory-like appearance of bone) found in osteoarthritis, rheumatoid arthritis, or both?

Osteoarthritis, due to the mechanical rubbing of bone on bone

32

• A woman with joint pains tests positive for anti-CCP antibodies. Name some systemic symptoms associated with her disease.

Fever, fatigue, weight loss, pleuritis, pericarditis (she has rheumatoid arthritis)

33

• What is the difference between the etiologies of osteoarthritis and rheumatoid arthritis?

Osteoarthritis is mechanical erosion of the articular cartilage, whereas rheumatoid

34

• What is the difference between the etiologies of osteoarthritis and rheumatoid arthritis?

Osteoarthritis is mechanical erosion of the articular cartilage, whereas rheumatoid arthritis is autoimmune, inflammatory joint destruction

35

• Is rheumatoid arthritis more prevalent in the male or female population?

Female population

36

• Eighty percent of patients with rheumatoid arthritis have what serologic finding?

Rheumatoid factor (anti-immunoglobulin G antibodies)

37

• What time of day is the stiffness of rheumatoid arthritis most intense. How long does it usually last?

Morning; usually more than 30 minutes

38

• Is the joint involvement in rheumatoid arthritis unilateral or symmetric? Inflammatory or noninflammatory?

Symmetric; inflammatory

39

• What type of arthritis tends to improve with use but often manifests with systemic symptoms?

Rheumatoid arthritis

40

• What are some classic findings seen on the hands of patients with rheumatoid arthritis?

Pannus formation (MCP, PIP), rheumatoid nodules (fibrinoid necrosis), ulnar finger deviation, subluxation, swan neck/boutonnière deformities

41

• Rheumatoid arthritis has a strong association with which human leukocyte antigen (HLA) complex?

HLA-DR4

42

• Name the finger joints usually spared in rheumatoid arthritis and osteoarthritis, respectively.

DIP joint and MCP joint

43

• ____ cysts are associated with rheumatoid arthritis and are found behind the knee.

Baker

44

• Despite a positive rheumatoid factor, the attending is not convinced that a patient has rheumatoid arthritis. What other test do you order?

Anti-cyclic citrullinated peptide antibody test (less sensitive but more specific)

45

• In rheumatoid arthritis, you expect to find ____ (increased/decreased/the same) amount of synovial fluid in the joint space.

Increased

46

• A man has joint pain, a swan neck deformity, and fevers. NSAIDs and COX-2 inhibitors do not work. What other treatment options can you try?

Glucocorticoids, disease-modifying agents (e.g., methotrexate, sulfasalazine), biologics (e.g., TNF-α inhibitors) (for rheumatoid arthritis)

47

• A 77-year-old woman has pain in her knees at the end of the day. What medical treatments might be considered?

Acetaminophen, NSAIDs, and intra-articular glucocorticoids (for osteoarthritis)

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