Arthritis

Question 1

Define OA

Answer 1

Degenerative joint disease resulting from aging, irritation, wear & tear

Question 2

Cause of OA

Answer 2

Abnormal joint mechanics, abnormal joint structure, previous injury, obesity.
1o Intrinsic alteration of articular tissues.
2o metabolic, anatomic, traumatic or inflammatory cause

Question 3

Joints affected in OA

Answer 3

Large, weight-bearing joints, usually lower limb. Often single joint involved.
1o DIP & i/mIP joints, 1st MTP & 1st CMC joints.
2o Knee & hip joints mainly

Question 4

Onset of OA

Answer 4

Slow & gradual

Question 5

Epidemiology/age of onset of OA

Answer 5

80% of population over 65.
1o postmenopausal women
2o men & women

Question 6

Course of OA

Answer 6

Chronic, degenerative. Intermittent acute exacerbations

Question 7

Pathological changes in OA

Answer 7

A disease of cartilage, Chondrocytes release enzymes that break down collagen & proteoglycans. Allows uptake of water, cartilage swells and splits. Fragments of cartilage in synovial fluid migrate to synovial membraneà synovitis. Exposed bone undergoes eburnation, hardening, with cyst formation in subchondral region. Eventually cysts collapse. Osteophyte formation at joint margins

Question 8

Clinical features of OA

Answer 8

Pain, stiffness, loss of ROM, loss of muscle power, crepitus, loss of function, swelling & deformity.
Nodules on IP joints of hand.

Question 9

Define RA

Answer 9

Chronic, systemic disease causing inflammatory polyarthritis and progressive joint damage

Question 10

Cause of RA

Answer 10

Unknown. Autoimmune disease.

Presence of Rheumatoid factor

Question 11

Joints affected in RA

Answer 11

Bilateral, symmetrical joint involvement. Small joints of the hands & feet affected first, larger joints late

Question 12

Onset of RA

Answer 12

May be slow & insidious. May be acute and sudden

Question 13

Epidemiology/age of onset of RA

Answer 13

Higher incidence in women. Any age of onset. Increased frequency in older individuals. 1% of population.

Question 14

Course of RA

Answer 14

Acute exacerbations with periods of remission

Question 15

Pathological changes in RA

Answer 15

A disease of the synovium. Chronic inflammatory reaction. Forms pannus that grows and spreads over the surface of hyaline cartilage, destroying it.
Secondary osteoarthritis.
Rheumatoid nodules may appear in subcutaneous tissues and other organs e.g. liver, spleen, lung, etc.

Question 16

Clinical features of RA

Answer 16

Pain, morning stiffness, loss of ROM, loss of muscle length & strength, crepitus, loss of function, heat, redness, tenderness.
Also fatigue, malaise, anorexia, fever, deformity, rheumatoid nodules. Anaemia

Question 17

Define AS

Answer 17

Chronic inflammatory arthritis with a predilection for the SI joints & spine. Characterised by progressive stiffening & fusion of the axial skeleton

Question 18

Cause of AS

Answer 18

Unknown. Autoimmune response possibly to gut infection in genetically predisposed persons carrying the HLA-B27 gen

Question 19

Joints affected in AS

Answer 19

SI joints, spinal facet joints, joints of the vertebral bodies, costo-vertebral, costo-transverse and costo-chondral joints. Progresses form lumbar to thoracic to cervical regions. Hip and TM joints may be affected and rarely, peripheral joints.

Question 20

Course of AS

Answer 20

Slow & insidious. Occasionally acute onset

Question 21

Epidemiology/age of onset of AS

Answer 21

More common in men. Women have more peripheral joint involvement. 20-30 years

Question 22

Course of AS

Answer 22

Gradually progressive, eventually leading to permanent stiffness. Periods of exacerbation & remission

Question 23

Pathological changes in AS

Answer 23

Inflammation of the synovial membrane of the SI and spinal facet joints with pannus formation that spreads over the joint cartilage à fibrous, & later, bony ankylosis.
Ligaments & capsule become inflamed, thickened & contract. Enthesopathy, syndesmophyte formation.
Bone becomes osteoporotic, muscle contractures, calcification of ligaments à ‘bamboo spine’.

Question 24

Clinical presentation of AS

Answer 24

Recurring episodes of LBP & stiffness à buttocks & thighs. Pain & tenderness over SIjoints.
Loss of spinal curves à thoracic & cervical kyphosis. Decreased height, gait abnormalities, loss of function. General malaise, anaemia, tenderness around pelvis region. Chest pain, decreased respiratory function. Respiratory problems and other systemic problems. May lead to cardiac problems