Arthiritis

Question 1

What kind of disease is rheumatoid arthritis?

Answer 1

Multisystem, autoimmune, degenerative disease

Question 2

What is the typical age of onset for rheumatoid arthritis?

Answer 2

Typically 25-40 y/o

Question 3

What percentage of rheumatoid arthritis patients have a positive family history?

Answer 3

5-10%

Question 4

Why would we ask about the pattern of disease activity?

Answer 4

Relentless progression
Flares separated by periods of remission

Question 5

How do the joints appear in osteoarthritis?

Answer 5

Red or swollen
Ulnar deviation of fingers
Wasting of intrinsic muscles of hands
Swelling of extensor tendon sheaths, MCP and PIP joints

Question 6

What duration of early morning stiffness is a marker for rheumatoid arthritis specifically?

Answer 6

> 30 mins

Question 7

What joints are usually affected?

Answer 7

MCP joints
PIP joints
DIP joints
MTP joints
Ankle
knee
Hip
wrist
elbow
shoulder

Question 8

What do we mean by the functional impact of rheumatoid arthritis?

Answer 8

How the disease has altered functional ability and is there anything that they now have difficulty doing
Consider mobility
Limitation of activities by pain, weakness etc.

Question 9

What are extra-articular features of rheumatoid arthritis?

Answer 9

Lung - dyspnoea
Skin - rash, vasculitic leg ulcers, rheumatoid nodules
Nervous system - Paraesthsiae (Carpal tunnel), peripheral neuropathy
Eyes - dry eyes (Sjogren’s syndrome), dry mouth, red eye (scleritis)
Renal - proteninuria or known dysfunction
Anaemia

Question 10

What drugs may be used to control rheumatoid arthritis?

Answer 10

Steroids
Analgesics
Non-steroidal anti-inflammatory drugs

Question 10

What do we focus on in a drug history?

Answer 10

Acceptability of the agent to patient
Time period of use
Efficacy
Reason for discontinuation
Doses used
Side affects

Question 11

What is the most important part of a history of a rheumatoid arthritis patient?

Answer 11

Social history and its functional impact

Question 12

Which gender is more likely to suffer from osteoarthritis?

Answer 12

Women by three-fold

Question 13

When does osteoarthritis usually present?

Answer 13

around 50 y/o

Question 14

How will the patient complain about the pain in osteoarthritis?

Answer 14

Pain on exertion but is relieved by rest
Pain is worse at the end of the day
Relief with rest is less complete as the disease progresses
Stiffness after periods of rest

Question 15

What is a major difference in joint pain between osteoarthritis and rheumatoid arthritis?

Answer 15

Osteoarthritis - asymmetrical (monoarthritis)
Rheumatoid arthritis - symmetrical (polyarthritis)

Question 16

In osteoarthritis, rank the most common joints with pain.

Answer 16

DIP joints
1st MCP joint
1st MTP joint
Hips and knees