W32 Osteoarthritis And Rheumatoid Arthritis Flashcards
(40 cards)
What are the medicines used for Osteoarthritis and Rheumatoid arthritis?
- Paracetamol
• NSAIDs
• Ibuprofen, Naproxen, or Diclofenac, or a Coxib (such as Celecoxib or Etoricoxib)
• Opioids
• Glucocorticoids
-Prednisolone, methylprednisolone and triamcinolone
• Conventional Disease Modifying Anti-Rheumatic Drugs (cDMARDs)
-Methotrexate, Leflunomide, Sulfasalazine, Hydroxychloroquine
• Tumor Necrosis Factor Alpha (TNFα) Inhibitors
• Biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs)
What is Arthritis?
● ‘inflammation of joint‘
● In common terms, arthritis is used to describe one of two conditions affecting joints:
o Osteoarthritis
-Common, slowly progressive deterioration in joints
o Rheumatoid arthritis
-An autoimmune disease of the joints
What is osteoarthritis?
• OA is the most common cause of arthritis, the most common disease of synovial joints, and is a major cause of disability.
• Age-related, progressive disorder
• Commonly affects weight bearing joints
• Knees, hips, spine, (hands)
• Characterized by:
• Progressive deterioration and loss of articular cartilage
• Pain and limitation of motion
• Progressive disability
• Inflammation may or may not be present
• Joint pain often eased by rest
• Pain worsens at end of the day
Diagnostics of Osteoarthritis:
What are the OA risk factors? (6)
- Age
- Obesity
- Injury
- Occupational overuse
- Female gender
- Family history
Which joints are affected in OA?
Any joint can be affected by OA
Joints most affected:
- Neck, lower back, hips, base of thumb, ends of fingers, knees, base of big toe
What are the treatment goals in osteoarthritis? (4)
- relieve pain;
- maintain mobility and function;
- prevent further joint damage;
- improve the patient’s mental health and quality of life
=Minimise impact on ADL & QoL
What is the management of Osteoarthritis?
- Patient education and counselling
- Physical therapies
- Physiotherapy and occupational therapy
- Correction of exacerbating factors
- Pharmacotherapy
- Simple analgesic (Paracetamol, Aspirin)
- NSAIDs (Topical vs systemic)
Non-pharmacologic approaches in OA?
- Weight loss - critical
- Physiotherapy, exercise programs,
-Strengthen supporting muscles - Massage, hot or cold packs (?acupuncture)
- Devices and aids (e.g., walking sticks)
- Surgery (e.g., joint debridement or joint replacement,)
-30% of patients - Not effective: Magnets & copper bracelets
Pharmacologic management – General principles in OA? (goals)
- Relieve symptoms (pain and stiffness)
- Improve joint function
- OA mainly affects older people
-co-existing conditions
-use conservative approach - Individualise therapy based on stage and severity of disability
Medication options for OA?
- Paracetamol
- Topical preparations
- Opioids
- NSAIDs
- Intra-articular corticosteroids
- Intra-articular hylans
-For knee (not usually recommended) - Anti-depressant
- Glucosamine & Chondroitin
Summary of OA management
Simple analgesics
* (e.g., Paracetamol)
Topical or oral NSAIDs PRN
* Consider topical capsaicin
Higher dose NSAIDs (plus Paracetamol) or Opioids (plus Paracetamol)
Corticosteroids (in severely affected joint that is inflamed)
* Intra-articular corticosteroid injection
Antidepressants (to alleviate depression associated with chronic pain and improve analgesic response)
Rheumatoid Arthritis (RA)
A joint affected by rheumatoid arthritis has what features? (3)
Osteoarthritis? (2)
- Inflamed synovium spreading across joint surface
- Thinning of cartilage
- Erosion into corner of bone
- Thinned cartilage
- Bone ends rub together
Short description of RA?
- RA – a chronic, progressive, inflammatory, systemic disease that primarily affects synovial joints.
- In the UK, about 1% of the population is affected.
- RA is 2–4 times **more common in women than in men
- Approximately one–third of people stop work because of RA within 2 years of its onset and this increases thereafter.
Immunopathology of RA?
➢Inflammation is the hallmark of active RA
➢ Activation of T cells by macrophages and unidentified antigens cause cytokine
release.
➢ Cytokines are also produced by synovial fibroblasts.
➢Primary problem is inflammation of the synovium – if uncontrolled –> bone erosions and structural damage to the joints
➢TNFa and IL-1, IL-2, IL-4 and IL-8 are important in the initiation and maintenance of inflammation and cartilage and bone damage and synovitis.
Clinical presentation of RA?– usually symmetrical
*Stiffness
*Usually, ~1 hour in the morning
*Swelling
*Tissue around joint may feel soft and spongy
*Red and warm
*Loss of function
*(e.g., grip strength)
*Systemic manifestations
*Eyes, lungs, heart, nerves….
*Often initial presentation is nonspecific inflammation
*Fever, malaise, weakness etc.
What is the Classic criteria for RA?
A diagnosis of definite RA requires at least four of the following criteria:
1. Morning stiffness for ≥ 1 h.
2. Arthritis of three or more joints and soft tissue swelling.
3. Arthritis of hand joints (wrist, MCP or PIP joints).
4. Symmetrical arthritis.
5. Rheumatoid nodules.
6. Serum RF (positive in ˂ 5% of normal control subjects).
7. Radiographic changes. Hand X-ray changes typical of RA must include erosions or unequivocal bony decalcification.
(1-4 must be continuously present for at least 6 weeks)
Investigations – common investigations in patients with RA (Primary Care)? (4)
- Offer – a blood test for rheumatoid factor (RF) in adults with RA who are found to have synovitis on clinical examination (positive in 60-70% of people with RA).
- Consider – anti-CCP antibodies in adults with suspected RA if they are negative for RF
(positive in about 80% of people with RA). - Arrange – X-ray the hands and feet in adults with suspected RA and persistent synovitis.
- Consider – FBC, RFT, LFT, CRP & ESR
Conclusive diagnosis of RA?(4)
- The occurrence of early morning stiffness
- Symmetrical painful polyarthritis
- High RF titre
- Joint erosions
ACR criteria 1, 2, 4, 6 and 7
Functional assessment of RA: (monitor response to treatment
- Duration of morning stiffness
- Grip strength
- Functional questionnaire: e.g. ability to dress, walk, open doors, turn taps, pick up small objects
- Degree of joint movement: e.g. fingers, arms, hips, knees; chest expansion, spinal extension when stooping
- Ability to perform activities of daily living: e.g. work related tasks, maintaining the home, child care
The aims of the RA management are..?
- Relieve pain and discomfort and ameliorate symptoms
- Arrest or limit disease progression and, if possible, reverse pathological changes
- Maintain mobility and function and promote the best possible quality of life.
Management of RA?– In simple words
- Non-pharmacological therapies
- Pharmacological therapies
- Drugs to control the disease process
- Drugs for symptoms
Management of RA?
- Patient education and counselling
- Physical: physiotherapy, osteopathy, occupational therapy, appliances, etc.
- Social: domestic assistance, modification of the home environment, financial support
- Pharmacotherapy: analgesics, anti-inflammatory agents (i.e., NSAIDs, anti-
cytokine drugs and corticosteroids), slow-acting (‘disease-modifying’) antirheumatic drugs (i.e., immunoregulators and antiproliferative
immunosuppressants) - Appropriate management of anaemia and other complications
- Psychiatric support
- Surgery: synovectomy, arthroplasty and other joint surgery
Non-pharmacologic management of RA?
- Patient education
- Physiotherapy
- Occupational therapy
- Hand exercise programme
- Podiatry
- Psychological interventions
- Diet and complementary therapies
-Mediterranean diet - Smoking cessation
-Linked to poor progression - Cardiovascular risk modification
-The systemic inflammation increases cardiac risk and patients should be monitored
