370.3: Arthritis (OA + RA) Flashcards
Osteoarthritis (OA)
Degenerative Disease that affect weight-bearing joints. Effects all components:
- Articular cartilage
- Menisci
- Bone
What are risk factors for OA?
- Age
- Female
- Hereditary Gene defect
- Joint alignment/injury
- Obesity
- Injuries (trauma, overuse, abnormal stress)
Idiopathic OA (primary OA)
- Unknown cause
- Not associated with known risk factors
- Most common type
- Usually asymmetrical involvement
Secondary OA
Associated with risk factors:
- Joint stress
- Congenital abnormalities
- Joint instability caused by trauma
What are physical characteristics of osteoarthritis (OA)?
- Erosion
- Subchondral sclerosis (thickening + hardening)
- Formation of born spurs (osteophytes)
What is the role of chondrocytes in osteoarthritis (OA)?
- Chondrocytes constantly remodel and maintain integrity of cartilage
- Create cartilage matrix by producing type 2 COLLAGEN + PROTEOGLYCANS
- Cannot effectively synthesize elements needed for maintaining cartilage
What happens to articular cartilage in osteoarthritis (OA)?
- Early, loses white/glistening appearance, becomes yellow-grey or brownish-grey
- Surface areas flake off and deeper layers develop longitudinal fissures (FIBRILLATION)
What is the pathophysiology of osteoarthritis (OA)?
- Cartilage becomes thin/absent, leaving the SUBCHONDRAL bone unprotected
- Sclerotic bone growth increase at the joint margins and bony outgrowths (OSTEOPHYTES) develop
- Synovial membrane becomes thickened, bits of bone and cartilage migrate into SYNOVIAL FLUID
- Pain and inflammation
What are the link all manifestations of osteoarthritis (OA)?
- New bone growth in hands
- Complete stiffness unusual except in hips
- Muscles around affected joint may be weaker and affect coordination + posture
- HEBERDEN’S Nodes (DIP)
- BOUCHARD’S Nodes (PIP)
Heberden Nodes (DIP)
Bony swellings of the joint closest to the fingertip.
Aka DIP joint (distal interphalangeal)
Bouchard’s Nodes (PIP)
Hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (PIP, the middle joints of fingers or toes). Caused by formation of calcific spurs of the articular cartilage.
What are diagnostic tests for osteoarthritis (OA)?
- Bone scan
- CT Scan
- MRI
- X-ray
- Synovial Fluid Analysis
What is the role of NSAIDS for osteoarthritis (OA)?
- Reduces pain
- Reduces inflammation
- Inhibits prostaglandins (inflammatory)
Ex. Ibuprofen, naproxen, voltaren
What is the role of COX-2 Inhibitors for osteoarthritis (OA)?
COX2 = secondary enzyme which selectively inhibits without disrupting GI system
Ex. Meloxicam, celecoxib, rofecoxib
What are the 2 types of steroid injections for osteoarthritis (OA)?
- Cortisone/ Corticosteroid
= ⬇️ inflammation around affected area
= more effective than NSAIDS - Viscosupplemetation
= insertion of small amount of HYALURONIC ACID into joint capsule
= Lubricating substance within joints lost in OA
What are Cell-surface antigens that are unique to every person?
- Human Leukocyte Antigens (HLAs)
2. Major Histocompatibility Complex (MHC)
What are the general characteristics of Rheumatoid Arthritis (RA)?
- Chronic inflammation of the connective tissue, esp joints
- Chronic, SYMMETRICAL, and erosive inflammation of synovial tissue of joints
- Progressive development of joint destruction, deformity, and disability
What are risk factors for Rheumatoid Arthritis (RA)?
- Age
- Female
- Weight (inflammation active in adipose tissue)
- Smoking
- Genetics (⬆️ HLAs)
What is the pathophysiology of Rheumatoid Arthritis (RA)?
- Initial immune response to an antigen
- Triggers formation of abnormal immunoglobulin (IgG)
- RF antibodies develop against IgG
- RF+IgG Form antibody-antigen immune complexes that deposit on SYNOVIAL membranes or articular cartilage
- Activation of complement system causes local inflammation
- SYNOVITIS
T-helper (CD4) cells and cytokines also involved in inflammatory response
When does joint changes begin in Rheumatoid Arthritis (RA)?
When hypertrophied synovial membrane invade surrounding:
- Cartilage
- Ligaments
- Tendons
- Joint capsule
- Subchondral bone
What is the formation of Pannus in Rheumatoid Arthritis (RA)?
Granulation tissue formed to cover the entire articular cartilage.
PANNUS = a highly vascularized fibrous scar tissue.
Errores and destroys entire surface of cartilage. Scars and shortens support structures (tendons + ligaments)
Results:
- Laxity (slack/loose)
- Subluxation
- Contracture
CYTOKINES further contribute to cartilage destruction
What are the signs of Stage 1 (Early) Rheumatoid Arthritis (RA)?
No destructive changes in X-ray
What are the signs of Stage 2 (Moderate) Rheumatoid Arthritis (RA)?
- Osteoporosis with or without slight bone/cartilage destruction
- NO joint deformities
- Adjacent muscle atrophy
What are the signs of Stage 3 (Severe) Rheumatoid Arthritis (RA)?
- Evidence of cartilage + bone destruction and osteoporosis
- Joint deformity (ex. Ulnar deviation)
- Extensive muscle atrophy
- WITHOUT fibrous or bony ANKYLOSIS
What are the signs of Stage 4 (Terminal) Rheumatoid Arthritis (RA)?
- Evidence of cartilage + bone destruction and osteoporosis
- Joint deformity (ex. Ulnar deviation)
- Extensive muscle atrophy
- WITH fibrous or bony ANKYLOSIS
Fibrous Ankylosis
Breakdown of bone resulting in fibrous connective tissue. Results in complete joint immobility.
Bony Ankylosis
Stage 5
No pain or swelling any more. Bone of joint collapses, forming a single unit of two bones. Makes joint extension impossible.
What are clinical manifestations of Rheumatoid Arthritis (RA)?
- Insidious onset
- Overall pain, swelling, and stiffness of joints and muscles (esp after sleep or rest)
- Fatigue, sleep disturbances
- Low grade FEVER
- Loss of ROM
- Loss of strength
- Joint deformity
What are common joints involved in Rheumatoid Arthritis (RA)?
- Proximal interphalangeal (PIP)
- Metacarpo-phalangeal (MCP)
- Wrists, elbows, + shoulders
- Cervical spine
- Hips, knees, ankles
- Metatarso-phalanges (MTP)
BILATERAL, SYMMETRICAL
Swan Neck Deformity
Deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it
(PIP hyperextension with DIP flexion).
Boutonnière Deformity
Deformed position of the fingers or toes, in which the joint nearest the knuckle (the proximal interphalangeal joint, or PIP) is permanently bent toward the palm while the farthest joint (the distal interphalangeal joint, or DIP) is bent back away.
(PIP flexion with DIP hyperextension).
What are physical signs in the hands of Late Stage (Stage 4) Rheumatoid Arthritis (RA)?
- Boutonnières deformity of thumb
- Ulnar deviation of metacarpo-phalange all joints
- Swan Neck Deformities of fingers
What are extra-articular manifestations of Rheumatoid Arthritis (RA)?
- Systemic symptoms (fatigue, FEVER)
- Renal: PROTEINURIA
- Raynauds neuropathy
- Pericarditis m, myocarditis, mitral valve disease
- Pleuritis, pulmonary fibrosis, pleural effusion
- Anemia
- Rheumatic nodules
- Vasculitic skin lesions
- Felty’s Syndrome (splenomegaly, leukopenia, lymphadenopathy, thrombocytopenia, leg ulcers)
Sjogren’s Syndrome
Chronic inflammatory disorder characterized by lymphocytic infiltration of lacrimales and salivary glands.
Impaired secretion of saliva and tears.
SICCA COMPLEX = dry mouth (XEROSTOMIA) and dry eyes (KERATOCONJECTIVITIS SICCA)
Rheumatoid Nodules
- Within first 2 years of onset
- Develop around small blood vessels
- Firm, mobile, painless
- Easily broken down or become infected
- Appear over extensor surface of joints
What are diagnostic tests for Rheumatoid Arthritis (RA)?
- Positive RF
- ⬆️ ESR (Erythrocytes Sedimentation Rate)
- ⬆️ CRP (C-reactive protein)
- ANA (Anti-nuclear antibodies)
- Synovial Fluid Analysis
➡️ Early = straw-coloured with many fibrin flecks
➡️ High WBC, mostly neutrophils
What are Acute Phase Reactants in Rheumatoid Arthritis (RA)?
- C-reactive Protein (CRP) = nonspecific response to inflammatory stimuli
- Erythrocyte Sedimentation rate (ESR) = inflammatory connective tissue disease
- C4 Complement = leads to inflammatory response
