OA vs. RA

Question 1

Osteoarthritis is a disease of the _____

Answer 1

Cartilage

Question 2

Primary form of OA increases exponentially after age ___

Answer 2

50 – due to aging

Question 3

OA affects the larger joints first. Specifically which ones for women and men?

Answer 3

Women - hands and knees

Men - hips

Question 4

What are the symptoms of OA?

Answer 4

Evening stiffness
Crepitus
Decreased ROM

Question 5

When are the symptoms worse for OA patients?

Answer 5

Worse with use

Question 6

Is there inflammation with OA?

Answer 6

No

Question 7

Is there systemic symptoms with OA?

Answer 7

No

Question 8

Is there morning stiffness with OA?

Answer 8

No

– Evening Stiffness

Question 9

When OA affects the proximal IP joints

Answer 9

Bouchard’s Nodes

Question 10

Bouchard’s nodes

Answer 10

OA affecting the proximal IP joints

Question 11

When OA affects the distal IP joints

Answer 11

Heberden nodes

Question 12

Heberden nodes

Answer 12

When OA affects the distal IP joints

Question 13

How do cracks form in the matrix with OA and what does that cause to occur?

Answer 13

Increased water content and decreased proteoglycans

=> cartilage sloughs off

Question 14

” joint mice or loose bodies”

Answer 14

Cartilage sloughing off with OA

Question 15

When cartilage sloughs off with OA, what occurs next and what is the pain experienced?

Answer 15

Subchondral bone exposed and rubbed smooth

= Eburnation: bone on bone pain

Question 16

Once Eburnation is present, what will develop in the bone and how?

Answer 16

Subchondral cysts

– microfractures allow synovial fluid into the bone

Question 17

What is the end stage OA?

Answer 17

Osteophytes (mushroom shaped bony growths)

Question 18

What do Osteophytes cause with OA?

Answer 18

Nerve compression and pain

Question 19

Rheumatoid Arthritis is a disease of the _____

Answer 19

Synovium

Question 20

Rheumatoid Arthritis is an autoimmune disease that affects which gender/age group more often?

Answer 20

Women 2-4th decades of life

Question 21

Is there systemic effects with RA?

Answer 21

Yes

Question 22

When is stiffness felt with RA?

Answer 22

Morning stiffness

Question 23

When are the symptoms worse with RA patients?

Answer 23

Worse with rest

Question 24

What type of inflammation is present with RA?

Answer 24

Non-suppurative inflammatory synovitis

Question 25

What marker is commonly present in the serum with most RA patients?

Answer 25

ACPAs

Question 26

What marker is not always present with RA and can be present in some patients that do not have RA?

Answer 26

Rheumatoid factor | -- IgM/A binds to the Fc region of IgG and deposits into joints

Question 27

OA is occurring slowly over time. When will joint symptoms present with RA?

Answer 27

Weeks/months

Question 28

What genetic abnormality is associated with RA?

Answer 28

HLA-DR4

Question 29

What environmental factors can influence RA?

Answer 29

Smoking | Infections

Question 30

What joints are affected first with RA and in what fashion?

Answer 30

Small joints of fingers first = symmetrical distribution

Question 31

How do the joints feel with RA?

Answer 31

Swollen Warm Painful -- morning stiffness that does NOT improve with rest

Question 32

With RA: Boutonniere

Answer 32

Flexed PIP | Extended DIP

Question 33

With RA: Swan-neck

Answer 33

Extended PIP | Flexed DIP

Question 34

With RA, what deviation will you see with the fingers and wrist?

Answer 34

``` Fingers = ulnar deviation Wrist = radial deviation ```

Question 35

Hyperplastic synovium that grows and erodes cartilage and causes joint fusion (ankylosis) to occur with RA?

Answer 35

Pannus

Question 36

Besides Pannus, what other morphological features can be seen with RA?

Answer 36

Synovial hypertrophy with villi Lymphoid aggregates Ankylosis (joint fusion) from the pannus

Question 37

What skin manifestations can be seen with RA?

Answer 37

Rheumatoid nodules

Question 38

Where do Rheumatoid nodules present?

Answer 38

Extensor surfaces at pressure points in subQ tissue | -- forearm, elbow, occiput, lumbar

Question 39

Are the Rheumatoid nodules tender?

Answer 39

NO

Question 40

Histo of the Rheumatoid nodules

Answer 40

Necrotizing granulomas with central fibrinoid necrosis