Arthritis Flashcards
What is osteoarthritis, and how does it occur?
Chronic synovial joint wear and tear.
Genetic factors, overuse, and injury -> imbalance between cartilage damage and chondrocyte response, causing structural issues in the joint
What are the risk factors for osteoarthritis?
obesity, age, occupation, trauma, being female, and family history
Which joints are commonly affected by osteoarthritis?
- Hips
- Knees
- Distal interphalangeal (DIP) joints in the hands
- Carpometacarpal (CMC) joint at the base of the thumb
- Lumbar spine
- Cervical spine (cervical spondylosis)
What are the X-ray findings in OA?
- Loss of joint space
- Osteophytes (bone spurs)
- Subarticular sclerosis (increased bone density along the joint line)
- Subchondral cysts (fluid-filled holes in the bone)
Do x-ray changes in osteoarthritis correlate with symptoms?
No, significant x-ray findings may not correlate with symptom severity.
How does osteoarthritis typically present?
JOINT PAIN AND STIFFNESS- worse with activity and at end of day
Morning stiffness lasting <30 mins
What are the general signs of osteoarthritis?
- Bulky, bony enlargement of the joint
- Restricted range of motion
- Crepitus on movement
- Joint effusions
What are specific signs of osteoarthritis in the hands?
Specific signs in the hands include:
- Heberden’s nodes (DIP joints)
- Bouchard’s nodes (PIP joints)
- Squaring at the base of the thumb (CMC joint)
- Weak grip
- Reduced range of motion
Why is the carpometacarpal (CMC) joint prone to osteoarthritis?
The CMC joint at the base of the thumb is a saddle joint subjected to high use, making it prone to wear.
What is the criteria for diagnosing OA without investigations? (NICE 2022)
MADE VIA HISTORY
criteria includes the patient being over 45, having typical activity-related pain, and having no morning stiffness or stiffness lasting under 30 minutes.
What are non-pharmacological management options for OA?
- Therapeutic exercise
- Weight loss if overweight
- Occupational therapy (e.g., walking aids, home adaptations)
What is the first-line pharmacological treatment for knee OA?
topical NSAIDs
When are oral NSAIDs recommended for OA, and what should they be co-prescribed with?
recommended when necessary, and should be co-prescribed with a proton pump inhibitor for gastroprotection
Further medical management for OA
Intra-articular steroid injections for up to 10 weeks
Hip and knee replacement in severe cases
What are the potential adverse effects of NSAIDs?
- Gastrointestinal: Gastritis, peptic ulcers, upper GI bleeding
- Renal: Acute kidney injury, chronic kidney disease
- Cardiovascular: Hypertension, heart failure, myocardial infarction, stroke
- Exacerbating asthma
Why should NSAIDs be used cautiously in patients with hypertension?
NSAIDs block prostaglandins, reducing vasodilation and potentially increasing blood pressure.
Why are opiates not helpful for chronic pain in osteoarthritis?
due to their association with side effects, dependence, and withdrawal without objective benefits
What is rheumatoid arthritis?
Autoimmune chronic symmetrical peripheral inflammatory polyarthritis
What joints do RA affect?
Synovial joints, including tending sheathe
Hence increases risk of tendon rupture
What are the consequences of untreated RA
Erosion and destruction- permanent damage and disability
RA risk factors
Anyone, but most at risk:
Middle aged women
Smokers
Obese
HLA DR4 family history
What causes RA?
Some have a genetic predisposition
Environmental trigger such as smoking activates it
How does RA present?
Pain, swelling, and prolonged morning stiffness
What is palindromic rheumatism?
Self limiting episodes of inf arthritis, that last a few days then resolve
May be a precursor to RA
How does RA present differently from OA?
RA is worst with rest and better with activity
RA is worst in the morning
Whereas OA is better with rest and in the morning, and worse with activity
RA typically does not affect DIPs
What joints are most commonly affected by RA?
MCPs, PIPs, wrists, and MTP tenderness
Systemic symptoms of RA
Fatigue, weight loss, flu like illness
What are the hand signs of RA?
Z shaped thumb
Swan neck- flexed DIP
Boutonnière- flexed PIP
Ulnar deviation of metacarpals
What is Feltys syndrome?
RA x neutropenia x splenomegaly
Extra articular signs of RA
Feltys
Anaemia
Cardio disease
Lymphadenopathy
Bilateral carpal tunnel syndrome
Amyloidosis
Bronchiolitis
Eye conditions
How is RA diagnosed?
Rheumatology referral for persistent synovitis and other symptoms
Antibodies, CRP, ESR, imaging
Squeeze test
What are the RA antibodies
Rf- present in about 70% of RA patients, but can be present in other conditions
AntiCCP- positive in about 80% of RA patients- often shows up before condition has been developed too
What are the scoring systems used for rheumatoid conditions?
ACR/EULAR
DAS28
HAQ
Management for RA
Lifestyle interventions, short term steroids for quick symptom control
Long term:
DMARDs
NSAIDs for pain but watch for side effects
Complications of RA
since it can increase fat metabolism it may lead to adverse cardiovascular effects
Atlantoaxial subluxation- c2 synovitis causing spinal cord compression
What is septic arthritis?
Acute joint infection -> can cause rapid joint destruction
What organisms can cause septic arthritis?
staph aureus
Neisseria gonorrhoea (if sexually active)
Strep A
Haemophilus influenza
E.coli
How does septic arthritis usually present?
Only affects one joint, commonly the knee
Rapid onset of:
Hot swollen red painful joint
Stiffness and reduced motion
Systemic features (inc. sepsis)
What can septic arthritis be confused with upon presentation?
Gout and pseudogout
Severe RA flare
Haemarthrosis
Septic arthritis management plan
Joint aspiration -> gram stain and culture, crystal microscopy
Meanwhile treat empirically with IV antibiotics until sensitivities known
Important to have low threshold for suspecting it, as it is very dangerous
What medication is used to treat septic arthritis?
Antibiotics normally continued for 4-6 weeks after
Flucloxacillin
Clindamycin if penicillin allergic
Vancomycin for MRSA
Ceftriaxone for gonnorhoea
