Arthritis

Question 1

What is arthritis?

Answer 1

Inflammation of one or more joints, causing pain and stiffness that can worsen with age.

Question 2

What is osteoarthritis?

Answer 2

inflammation of bone and joint cartilage.

Question 3

What is the most common form of osteoarthritis?

Answer 3

Degenerative and
Mechanical arthritis.

Question 4

What is the cause of osteoarthritis?

Answer 4

Chronic wear and tear of articular cartilage.

Question 5

What are the risk factors of osteoarthritis?

Answer 5

Age: prolonged/repetitive stress on joints

• Obesity: increased weight means increased stress on joints

• Genetics: genetic defects

• Sex: more common in females

• Physical activity: severe injury

• Occupation: overuse

Question 6

What do you expect to happen to the bones affected by osteoarthritis?

Answer 6

Due to cartilage destruction = joint space narrowing

• Due to synovial leaking into cartilage defects = subchondral cysts

• Due to bone rubbing against bone = stress = bone remodelling = abnormal outgrowths called osteophytes

• Due to bone rubbing against bone = thickens = subchondral sclerosis

Question 7

What are the 4 classical findings on joint X-ray of osteoarthritis?

Answer 7

Joint space narrowing
Subchondral cysts
Subchondral sclerosis
Osteophytes

Question 8

Which parts of the body does osteoarthritis affect mainly?

Answer 8

Hands
Knees
Hip
Neck
Lower back

Question 9

How do you diagnose osteoarthritis?

Answer 9

Confirmed with imaging X-ray
1. Joint space narrowing
2. Osteophytes
3. Subchondral cysts
4. Subchondral sclerosis

MRI
1. Cartilage defects, joint effusions

Question 10

Treatment?

Answer 10

Non-pharmacological: weight loss, moderate exercise

• Pharmacological: reduce pain and inflammation:
• Hyaluronic acid injections

• Joint replacement

Question 11

What is Rheumatoid arthritis?

Answer 11

A chronic inflammatory disorder affecting many joints, including those in the hands and feet.

In rheumatoid arthritis, the body’s immune system attacks its own tissue, including joints.

Question 12

What are the risk factors of Rheumatoid?

Answer 12

Genetic predisposition: HLA-DR1 and HLA-DR 4

• Lifestyle: cigarette smoking and obesity

• Infections: EBV, Parvo, Hepatitis B and C

Question 13

What happens in rheumatoid?

Answer 13

• B cells produce antibodies (rheumatoid factor) against citrulline
• Synovium infiltrated by immune cells which produce cytokines that
further inflammation, cartilage destruction.

Question 14

What joints are commonly affected in rheumatoid?

Answer 14

Small joints are affected and it’s symmetrical

hands (PIP, MCP), wrists and knees

Question 15

What are the symptoms of rheumatoid?

Answer 15

Pain

• Morning stiffness (more than one hour)

• Tenderness and swelling

• Reduced grip strength

• Ulnar deviation of MCP

• Boutonneire deformity: flexed PIP and hyperextended DIP

• Swan neck deformity: hyperextended PIP and flexed DIP

• Hitchhiker thumb (Z deformity): flexed MCP and hyperextended

Question 16

What are the systematic manifestation of rheumatoid?

Answer 16

Rheumatoid nodules mainly on hands and elbow.
• Skin ulcers
• Ocular e.g uveitis
• Neurologic e.g carpal tunnel syndrome

Question 17

What will you look for on physical examination of suspected rheumatoid arthritis?

Answer 17

Swan neck deformity
Stiffness of joints
Tenderness and swelling
Reduced grip strength
Ulnar deviation
Redness of affected joints
Mobility of joints
Comparing affected joints with unaffected if any

Question 18

What investigations would you carry out for rheumatoid?

Answer 18

Blood tests
Imaging; X-ray, MRI
CRP
Synovial fluid investigations
Leukocytosis

Question 19

What treatment options would you give a rheumatoid pt?

Answer 19

Pharmacological- DMARD( disease modifying anti rheumatic drugs), NSAIDS.

Non pharmacological- cessation of smoking

Surgery- joint replacement and synovectomy

Question 20

What questions will you ask in taking hx of a rheumatoid pt?

Answer 20

Are you experiencing any fever?

Morning stiffness, if yes then how long does it last?

Where is the pain?
Can you point to where it is?
Did the pain come on suddenly or gradually?
When did the pain first start?
How long have you had the pain?
How would you describe the pain?( dull ache, burning or sharp?
Does the pain spread elsewhere?
Are there any other symptoms associated with the pain?
Is the pain constant or does it come and go?
Is the pain worse at a particular time of the day?
Does anything make the pain worse or better?
On a scar of 0-10 how severe is the pain?

Have you noticed any skin changes or rash?
Have you noticed any nail changes?

Which joints have become swollen and when did that start?”
“Is the joint swelling painful?”
“Does the joint swelling impact your daily activities?”
“Have you noticed any associated redness of skin overlying the swollen joints?”

Question 21

What is gout?

Answer 21

• Metabolic disease associated with elevated serum uric acid levels (greater than 6.8mg/dL) and abnormal deposition of monosodium urate in tissues.

• Classified as metabolic arthritis

Question 22

What risk factors are associated with gout?

Answer 22

• Diet: high meat and seafood diets, fructose containing drinks and alcoholic drinks
• Obesity
• Family history, Certain drugs, Other chronic diseases..etc.

Question 23

What are the symptoms of gout?

Answer 23

Classical signs of inflammation • Tender joints
• Warm in the joints
• Joint redness
• Swellin
Joint dysfunction

Question 24

How to diagnose gout?

Answer 24

Blood
• Hyperuricemia
• Elevated WBC
• Elevated ESR
Other
• Synovial fluid analysis

Question 25

Management of gout?

Answer 25

Dietary changes: less purine rich foods and alcohol intake
• NSAIDS e.g ibuprofen,
• Corticosteroids: oral or injection, e.g prednisone
• Drugs that block uric acid production: allopurinol