Osteoarthritis and Chronic Inflammatory Arthritis Flashcards Preview

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Flashcards in Osteoarthritis and Chronic Inflammatory Arthritis Deck (43):
1

Osteoarthritis

Also known as degenerative arthritis - characterized by degeneration of articular cartilage

2

What is the most common type of osteoarthritis?

Primary

3

What are the causes of secondary osteoarthritis?

- Trauma
- Inflammatory Arthritis
- Hereditary Conditions
- Kashin-Bek Disease: Joint hypermobility
- Bone and Endocrine Disorders

4

What is the main population for osteoarthritis?

Elderly - more than 65 yrs

5

What are the risk factors of osteoarthritis?

- Age
- Obesity
- Repetitive Impact
- Genetics

6

What are the clinical characteristics of osteoarthritis?

 Localized joint pain
 Stiffness
 Worse with weight bearing
 Better with rest
 Very little morning stiffness

7

What happens to the joints of the hand with osteoarthritis?

Distal & Proximal interphalangeal joints
- Heberdens & Bouchards nodes

8

What are some large joints affected by osteoarthritis?

- Knees
- Hips
- Cervical Spine

9

What will the x-ray of osteoarthritis show?

- Decreased joint space
- Osteophytes
- Subchondral Sclerosis

10

What is the treatment for osteoarthritis?

- Weight loss/Physical therapy
- NSAIDs
- Joint Replacement

11

Rheumatoid Arthritis

 Systemic
 Chronic
 Inflammatory
 Autoimmune

12

What can rheumatoid arthritis also affect?

Primarily involves joints but can affect extra-articular organs - lungs, blood, eyes, skin, heart, etc.

13

What gender is rheumatoid arthritis more common in?

Women

14

What gene is associated with rheumatoid arthritis?

HLA-DRB1

15

Does OA have swelling?

No

16

Which type of arthritis has morning stiffness?

RA

17

What type of arthritis involves the lumbar spine?

OA

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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.

19

Pannus

Pannus is an abnormal layer of fibrovascular tissue or granulation tissue. In RA it can be vascular, dense and layered.

20

What are some lab indications of RA?

- Anti-CCP antibody
- Elevated inflammatory markers

21

Rheumatoid Nodule

Area of fibrinoid necrosis (center) surrounded by palisading histiocytes

22

What is the treatment for rheumatoid arthritis?

- NSAIDs
- Corticosteroids
- DMARDS

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Anakinra MOA

Anti-IL1

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Etanercept, Adalimumab, Infliximab MOA

Anti-TNF alpha

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Tocilizumab MOA

Anti-IL 6

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Abatacept MOA

CTLA4 agonist
- Blocks CD28 co-stimulation of T cells

27

Rituximab MOA

Anti-CD20
- Causes destruction of B cells

28

Tofacitinib MOA

JAK1 and 3 inhibitor
- Blocks signaling for inflammatory cytokines

29

Seronegative Spondyloarthropathy

Group of inflammatory arthritides which primarily involve ankylosing of the spine that improves with exercise but NOT with rest

30

What extra-articular manifestations can seronegative spondyloarthropathy have?

- Uveitis
- GU Tract
- Skin

31

What is the typical patient of seronegative spondyloarthropathy?

Caucasian between 16 and 30 yrs

32

What are some pathogenesis theories of seronegative spondyloarthropathy?

- Molecular mimicry following an infection
- Misfolding and dimerization leads to inappropriate stimuli and inflammation

33

What are the important molecules in the pathogenesis of seronegative spondyloarthropathy?

- TNF
- IL-17 - important in defense against bacteria but dysregulation leads to joint destruction
- IL-23

34

What are some of the effects of IL-17?

 Increase in proinflammatory cytokines
 Increase in metalloproteinase
 Increase in RANKL activity

35

Sacroiliitis

- 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

36

Spinal Ankylosis

 Spinal inflammation
 Spinal ankylosis

37

Syndesmorphytes

Sclerosising and squaring of the vertebral corners - can lead to complete bridging ossification

38

What GI disease is seronegative spondyloarthropathy associated with?

- Crohn's Disease
- Ulcerative Colitis

39

What type of arthrtitis will have pain increase throughout the day after weight bearing?

OA

40

What arthritis does smoking have a lot of correlation with?

RA

41

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

42

What is the first line biologic for RA?

Anti-TNF alpha drugs

43

What are the only biologics that work in spondyloarthropathy?

Anti-TNF alpha drugs

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