Flashcards in Osteoarthritis and Chronic Inflammatory Arthritis Deck (43)
Also known as degenerative arthritis - characterized by degeneration of articular cartilage
What is the most common type of osteoarthritis?
What are the causes of secondary osteoarthritis?
- Inflammatory Arthritis
- Hereditary Conditions
- Kashin-Bek Disease: Joint hypermobility
- Bone and Endocrine Disorders
What is the main population for osteoarthritis?
Elderly - more than 65 yrs
What are the risk factors of osteoarthritis?
- Repetitive Impact
What are the clinical characteristics of osteoarthritis?
Localized joint pain
Worse with weight bearing
Better with rest
Very little morning stiffness
What happens to the joints of the hand with osteoarthritis?
Distal & Proximal interphalangeal joints
- Heberdens & Bouchards nodes
What are some large joints affected by osteoarthritis?
- Cervical Spine
What will the x-ray of osteoarthritis show?
- Decreased joint space
- Subchondral Sclerosis
What is the treatment for osteoarthritis?
- Weight loss/Physical therapy
- Joint Replacement
What can rheumatoid arthritis also affect?
Primarily involves joints but can affect extra-articular organs - lungs, blood, eyes, skin, heart, etc.
What gender is rheumatoid arthritis more common in?
What gene is associated with rheumatoid arthritis?
Does OA have swelling?
Which type of arthritis has morning stiffness?
What type of arthritis involves the lumbar spine?
What is the pathogenesis of rheumatoid arthritis?
Activation of CD4+ helper T cells that leads to the generation of a pro-inflammatory milieu with destructive enzymes and increased osteoclast activation that can cause bone erosions.
Pannus is an abnormal layer of fibrovascular tissue or granulation tissue. In RA it can be vascular, dense and layered.
What are some lab indications of RA?
- Anti-CCP antibody
- Elevated inflammatory markers
Area of fibrinoid necrosis (center) surrounded by palisading histiocytes
What is the treatment for rheumatoid arthritis?
Etanercept, Adalimumab, Infliximab MOA
- Blocks CD28 co-stimulation of T cells
- Causes destruction of B cells
JAK1 and 3 inhibitor
- Blocks signaling for inflammatory cytokines
Group of inflammatory arthritides which primarily involve ankylosing of the spine that improves with exercise but NOT with rest
What extra-articular manifestations can seronegative spondyloarthropathy have?
- GU Tract
What is the typical patient of seronegative spondyloarthropathy?
Caucasian between 16 and 30 yrs
What are some pathogenesis theories of seronegative spondyloarthropathy?
- Molecular mimicry following an infection
- Misfolding and dimerization leads to inappropriate stimuli and inflammation
What are the important molecules in the pathogenesis of seronegative spondyloarthropathy?
- IL-17 - important in defense against bacteria but dysregulation leads to joint destruction
What are some of the effects of IL-17?
Increase in proinflammatory cytokines
Increase in metalloproteinase
Increase in RANKL activity
- Granulation tissue erodes through bone and cartilage into joint cavity
- Infiltration of subsynovium: macrophages, lymphocytes, plasma cells
- Osteoblasts eventually replace cartilage with new bone which is called ankylosis
Sclerosising and squaring of the vertebral corners - can lead to complete bridging ossification
What GI disease is seronegative spondyloarthropathy associated with?
- Crohn's Disease
- Ulcerative Colitis
What type of arthrtitis will have pain increase throughout the day after weight bearing?
What arthritis does smoking have a lot of correlation with?
What are the main differences between RA and OA?
RA will often be symmetrical and will affect many joints as well as have extra-articular involvement and inflammatory cells
What is the first line biologic for RA?
Anti-TNF alpha drugs