R/O - Osteoarthritis

Question 1

what type of arthritis is osteoarthritis?

Answer 1

hypertrophic

Question 2

what is the most common form of arthritis?**

Answer 2

osteoarthritis

Question 3

what are the two subtypes of primary OA?

Answer 3

• localized

- generalized

Question 4

what are the subtypes of generalized primary OA?

Answer 4

• nodal
• erosive
• inflammatory

Question 5

OA / DJD definition:

Answer 5

degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth

Question 6

what are the radiographic signs of OA / DJD?**

Answer 6

• joint space narrowing
• subchondral sclerosis
• ostephyte formation

Question 7

pathology of OA / DJD

Answer 7

• articular cartilage loss
• osteophyte and bony sclerosis development
• inflammatory infiltrates in the synovium
• lax ligaments
• weak muscles

Question 8

symmetric polyarthritis - likely diagnosis?

Answer 8

OA

Question 9

how is OA different from RA?

Answer 9

• inolvement DIP, PIP, IP, first MP, CMC

- bony enlargement (bouchards nodes) - RA is doughy when squeezed

Question 10

what is the pharmacological therapy for OA?

Answer 10

ORAL:

• acetaminophen
• oral NSAIDs
• topical NSAIDs
• tramadol
• duloxetine (NR)
• opioids (NR)

INTRA-ARTICULAR:

• hyaluronates
• glucocorticoids

TOPICAL:

• capsaicin (hand only)
• diclofenac (NSAID)

Question 11

what is one advantage of COX-2 specific NSAIDs over normal NSAIDs?

Answer 11

lower risk of GI adverse effects than NSAIDs

Question 12

RA general features**

Answer 12

• multisystem, autoimmune disease
• NOT a benign “joint disease”
• high rates of diability
• increased early mortality

Question 13

diagnostic classification of RA:

Answer 13

• morning stiffness
• arthritis of 3 or more joint areas
• arthritis of hand joints
• symmetric arthritis
• rheumatoid nodules
• serum rheumatoid factor
• radiographic changes

Question 14

morning stiffness in inflammatory arthritis (such as RA) lasts for how long?

Answer 14

at least an hour

Question 15

what marker is specific but not sensitive for RA?

Answer 15

• anti-CCP (anti-cyclic citrillinated peptide) antibody

Question 16

what are the lab findings in RA?

Answer 16

• Rf
• anti CCP
• acute phase reactants
• ANA

Question 17

what are the joint morphology changes in RA?

Answer 17

• synovitis
• bone erosion
• pannus
• cartilage degradation (joint space narrowing)

Question 18

what is the pathologic hallmark of RA?

Answer 18

rheumatoid erosions

Question 19

periarticular osteopenia is seen in which type of arthritis?

Answer 19

RA

Question 20

what is Caplan’s syndrome?

Answer 20

rheumatoid nodules PLUS pneumoconiosis

Question 21

what is the role of NSAIDs in RA?

Answer 21

symptomatic relief ONLY (pain and stiffness)

Question 22

what is the gold standard treatment for RA?

Answer 22

methotrexate

Question 23

what are the adverse effects of methotrexate?

Answer 23

• hepatic fibrosis
• bone marrow toxicity
• pulmonary toxicity
• nuisance side effects

Question 24

what are the TNFa biologics for RA?

Answer 24

• infliximab
• etanercept
• adalimumab
• certolizumab
• golimumab

Question 25

what is the T cell activity biologic drug?

Answer 25

abatacept

Question 26

what is the B cell activity biologic drug?

Answer 26

rituximab

Question 27

what is the IL-1 activity biologic drug?

Answer 27

anakinra

Question 28

what is the IL-6 activity biologic drug?

Answer 28

tocilizumab

Question 29

what is the JAK activity biologic drug?

Answer 29

tofacitinib

Question 30

what is the most POTENT medication for RA? they are usually used in combination with what other drugs?

Answer 30

- anti TNFa therapies | - methotrexate