Osteoarthritis and Rheumatoid arthritis

Question 1

Osteoarthritis:

Answer 1

Degeneration of cartilage in joints resulting in pain, deformity and loss of function

Question 2

osteoarthritis etiology:

Answer 2

physical stress, abnormal healing after injury, genetics

Question 3

Osteoarthritis epidemiology:

Answer 3

• typically over 65

- women twice as much as men

Question 4

joints most likely to be affected by osteoarthritis:

Answer 4

• Hands
• cervical spine
• lumbosacral spine
• hips
• knees
• foot (1st MTP)
• but can affect any joint

Question 5

osteoarthritis symptoms:

Answer 5

• joint pain
• movement exacerbates pain
• stiffness
• gradual onset, progresses
• intermittent flares

Question 6

Osteoarthritis physical exam feats:

Answer 6

• heberdens nodes
• bouchards nodes
• joint deformity
• loss of function

Question 7

heberdens nodes:

Answer 7

bony enlargement of DIP

Question 8

Bouchards nodes:

Answer 8

• less common

- bony enlargement of PIP

Question 9

osteoarthritis imaging:

Answer 9

• osteophytes
• loss of cartilage (joint narrowing)
• bony sclerosis
• not seen till later

Question 10

osteoarthritis tx:

Answer 10

• acetominophen
• NSAIDS
• intra-articular injections (steroids or hyaluronic acid)
• topicals
• surgery if bad enough

Question 11

Rheumatoid arthritis:

Answer 11

• chronic, progressive, inflammatory autoimmune disease characterized by symmetric, peripheral arthritis
• onset 25-55
• women>men

Question 12

RA small joints affected:

Answer 12

MCP
PIP
MTP
Thumb interphalangeal
Wrist

Question 13

RA large joints affected:

Answer 13

shoulder
elbow 
hip
knee
ankle
C1-C2

Question 14

RA symptoms:

Answer 14

-joint pain
-stifness 1+ hrs
-joint swelling
-loss of function
-general fatigue and aching
-Subcutaneous nodules, eye involvement, pulmonary involvement, vasculitis, weight loss, etc
Fever – may indicate vasculitis

Question 15

1 major way OA and RA are different?

Answer 15

RA is a systemic disease

Question 16

RA criteria:

Answer 16

These patients must achieve a total score of 6 or greater (of a possible 10) from the individual scores in four domains:
number and site of involved joints (range 0–5),
serological abnormality (range 0–3),
elevated acute-phase response (range 0–1)
symptom duration (two levels; range 0–1).

Question 17

RA physical exam feats:

Answer 17

• boutonneire deformity

- swan neck deformity

Question 18

RA course of disease:

Answer 18

Chronic inflammatory disease with acute flares
Progressive deformities and disability in most patients
Progression is variable, but major loss of function occurs within first two years
This is why the treatment strategy has shifted to earlier and more aggressive treatment
Associated with shortened life expectancy

Question 19

RA laboratory eval:

Answer 19

• elevated rheumatoid factor

- anti-cyclic citrullinated peptide antibodies

Question 20

Drug therapy for RA:

Answer 20

• DMARDS

- NSAIDS

Question 21

Juvenile idiopathic arthritis some key features:

Answer 21

Diagnosis prior to age 16
5 different subtypes; primarily a clinical diagnosis
Most common presentation is oligoarthritis
4 or less joints affected
Typically presents with gait disturbance and joint swelling
May persist into adulthood
30-50% will still have disease 10 years post-onset
Treatment goals same as in adults – early aggressive treatment to minimize any sequelae