Arthritis Flashcards
Define OA
Degenerative joint disease resulting from aging, irritation, wear & tear
Cause of OA
Abnormal joint mechanics, abnormal joint structure, previous injury, obesity.
1o Intrinsic alteration of articular tissues.
2o metabolic, anatomic, traumatic or inflammatory cause
Joints affected in OA
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
Onset of OA
Slow & gradual
Epidemiology/age of onset of OA
80% of population over 65.
1o postmenopausal women
2o men & women
Course of OA
Chronic, degenerative. Intermittent acute exacerbations
Pathological changes in OA
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
Clinical features of OA
Pain, stiffness, loss of ROM, loss of muscle power, crepitus, loss of function, swelling & deformity.
Nodules on IP joints of hand.
Define RA
Chronic, systemic disease causing inflammatory polyarthritis and progressive joint damage
Cause of RA
Unknown. Autoimmune disease.
Presence of Rheumatoid factor
Joints affected in RA
Bilateral, symmetrical joint involvement. Small joints of the hands & feet affected first, larger joints late
Onset of RA
May be slow & insidious. May be acute and sudden
Epidemiology/age of onset of RA
Higher incidence in women. Any age of onset. Increased frequency in older individuals. 1% of population.
Course of RA
Acute exacerbations with periods of remission
Pathological changes in RA
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.
Clinical features of RA
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
Define AS
Chronic inflammatory arthritis with a predilection for the SI joints & spine. Characterised by progressive stiffening & fusion of the axial skeleton
Cause of AS
Unknown. Autoimmune response possibly to gut infection in genetically predisposed persons carrying the HLA-B27 gen
Joints affected in AS
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.
Course of AS
Slow & insidious. Occasionally acute onset
Epidemiology/age of onset of AS
More common in men. Women have more peripheral joint involvement. 20-30 years
Course of AS
Gradually progressive, eventually leading to permanent stiffness. Periods of exacerbation & remission
Pathological changes in AS
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’.
Clinical presentation of AS
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
