5. Osteoarthritis and Reactive Arthritis

Question 1

Recall the joints most commonly affected by osteoarthritis

Answer 1

In the hand: 1st CMC to thumb, PIPs, DIPs
Spine
Weight bearers (hips, knees)

Question 2

What is the cause of osteoarthritis?

Answer 2

Excessive loading on joints

Question 3

Describe the normal composition of synovial fluid

Answer 3

Rich in hyaluronic acid

Question 4

Describe the normal composition of articular cartilage

Answer 4

Rich in type II collagen and aggrecan

Question 5

What is the purpose of aggrecan and where is it found in joints?

Answer 5

Negative charge retains water

Found in articular cartilage

Question 6

Recall 3 pathological changes seen in osteoarthritis

Answer 6

Reduced aggrecan
Reduced collagen
Chondrocyte apoptosis

Question 7

What is the consequence of chondrocyte apoptosis in osteoarthritis?

Answer 7

Subsequent bone damage, leading to node formation

Question 8

Recall 2 clinical features of osteoarthritis

Answer 8

Heberden’s nodes (at DIPs)

Bouchard’s nodes (at PIPs)

Question 9

How does activity affect joint pain in osteoarthritis?

Answer 9

Makes it worse since it is a mechanical aetiology

Question 10

Recall 4 features of the joints in osteoarthritis

Answer 10

Pain
Crepitus
Instability
Enlargement (nodes)

Question 11

What is an osteophyte?

Answer 11

Radiological image of a joint swelling

Question 12

Recall a unique radiological feature of osteoarthritis

Answer 12

Osteophytes

Question 13

Recall a radiographic feature that is common to both osteoarthritis and rheumatoid arthritis?

Answer 13

Joint narrowing

Question 14

What is the gold standard treatment for osteoarthritis?

Answer 14

Joint replacement

Question 15

How is reactive arthritis defined?

Answer 15

Sterile inflammation of joint following infection

Question 16

What sort of joints are affected by osteoarthritis?

Answer 16

Synovial

Question 17

Describe the pattern and sort of joints are affected by reactive arthritis?

Answer 17

Asymmetrical
Oligoarticular
Only large joints

Question 18

What sorts of infection are most likely to result in reactive arthritis?

Answer 18

Urogenital or GIT

Question 19

What particular viruses are associated with reactive arthritis?

Answer 19

Hep C

HIV

Question 20

Which gender is most likely to be affected by rheumatoid arthritis?

Answer 20

Females (it’s AI)

Question 21

Which gender is most likely to be affected by reactive arthritis?

Answer 21

Men

Question 22

What age group is most likely to be affected by reactive arthritis?

Answer 22

20-40

Question 23

Recall 4 important extra-articular manifestations of reactive arthritis

Answer 23

Enthesopathy
Psoriasis-like rash
Spondylitis
Urethritis

Question 24

Recall the HLA association of reactive arthritis

Answer 24

HLA-B27

Question 25

Recall 3 important diagnostic tests for reactive arthritis?

Answer 25

1. Microbiology sample of synovial fluid 2. RF (to exclude rheumatoid) 3. Synovial fluid exam (one joint affected indicates septic arthritis)

Question 26

Recall 3 inflammatory manifestations of reactive arthritis outside of the joints

Answer 26

Achilles tendonitis Plantar fasciitis Dactylitis

Question 27

What is the name of the psoriasis-like rash seen in reactive arthritis

Answer 27

Keratoderma blenorrhagicum

Question 28

Recall the management strategy for reactive arthritis

Answer 28

NSAIDS Corticosteroids NO antibiotics May use topical steroid for extra-articular manifestations