Arthritis

Question 0

Epidemiology

0.8% of adult population with onset beginning between ages 30-80 years

Answer 0

Rheumatoid arthritis

Question 1

Epidemiology

Most common arthropathy in adults

Answer 1

Osteoarthritis

Question 2

Degenerative changes with progressive loss of cartilage and hypertrophic changes in surrounding bone

Answer 2

What is osteoarthritis

Question 3

Chronic, inflammatory, systemic autoimmune disease.

Answer 3

What is rheumatoid arthritis

Question 4

Who gets osteoarthritis

Answer 4

Who

Most common in older people, women>men; risk factors = obesity, family history, metabolic disorders, neuromuscular dysfunction

Question 5

Who gets rheumatoid arthritis

Answer 5

Peak incidence in young adults; more common in women

Question 6

When are symptoms present in osteoarthritis

Answer 6

When are symptoms present

Joint pain worsens with activity and improves with rest, worse in the evening. Stiffness is experienced more in the evening and after sitting for extended periods

Question 7

When are symptoms present in rheumatoid

Answer 7

When are symptoms present

Morning stiffness greater than one hour.

Question 8

Where is the pain of osteoarthritis located

Answer 8

Where is the pain located

Variable; asymmetrical distribution: hands, knees, hips

Question 9

Where is the pain of rheumatoid arthritis located

Answer 9

Where is the pain located

Symmetrical; smaller joints affected first, as disease progresses other joints affected. Deformity is common.

Question 10

Diagnostic Tests/P.E. for osteoarthritis

Answer 10

Diagnostic Tests/P.E.

None; may see Herbeden nodules on exam, bony enlargement, joint instability, restricted movement. Osteophytes on x-ray.

Question 11

Diagnostic Tests/P.E. For rheumatoid arthritis

Answer 11

Diagnostic Tests/P.E.

Rheumatoid Factor, enzyme assays, CRP, ESR, CBC, and x-rays used to stage disease.

Question 12

Goal of Therapy for osteoarthritis

Answer 12

Goal of Therapy

Pain relief and maintain functioning

Question 13

Goal of Therapy for rheumatoid arthritis

Answer 13

Goal of Therapy

Minimize joint pain and damage, control systemic involvement, prevent disease progression and avoid side effects of medications.

Question 14

Treatment approaches for osteoarthritis

Answer 14

Treatment approaches

NSAIDS, yoga, muscle stretching, lidocaine patch.

Question 15

Treatment approaches for rheumatoid

Answer 15

Treatment approaches

Acetaminophen, NSAIDS, PPI, prednisone, anti-rheumatic drugs, biologic response modifiers, PT/OT.

Question 16

Morbidity for osteoarthritis

Answer 16

Morbidity

Secondary diagnoses are bigger issue, as well as immobility!

Question 17

Morbidity for rheumatoid arthritis

Answer 17

Morbidity

If not treated, severe disability can occur within 10 years of diagnosis.

Question 18

What is Sjogren’ syndrome

Answer 18

Sjogren syndrome is an autoimmune disorder in which the glands that produce tears and saliva are destroyed. This causes dry mouth and dry eyes. The condition may affect other parts of the body, including the kidneys and lungs.

Question 19

Who gets Sjögren’s syndrome

Answer 19

Most people with Sjögren’s syndrome are women. It can occur at any age and in any race. But it is rare in children and most often shows up after age 40.

Question 20

What causes Sjögren’s

Answer 20

It is an autoimmune disorder.

In Sjögren’s syndrome, your immune system attacks the glands that make tears and saliva (spit). The damage keeps these glands from working right and causes dry eyes and dry mouth.

Question 21

Dx of Sjögren’s using criteria

Need 4 (study guide said 3) of the following ….AECG CRITERIA

Answer 21

American-European Consensus Group (AECG) classification criteria for definitive diagnosis of Sjogren syndrome
applies to patients with signs or symptoms of Sjogren syndrome
case definition requires ≥ 4 of the following 6 criteria in patients with positive results for histology or serology

ocular symptoms (≥ 1 of the following)
chronic, daily, troublesome dry eyes > 3 months
recurrent sensation of gravel or sand in eyes
use of tear substitutes > 3 times daily

oral symptoms (≥ 1 of the following)
daily sensation of dry mouth > 3 months
recurrent or persistently swollen salivary glands in adulthood
frequent ingestion of liquids to assist in swallowing dry food

ocular signs (positive results on ≥ 1 of the following tests)
Schirmer test for tear function performed without anesthesia (positive result ≤ 5 mm of tears in 5 minutes)
Rose Bengal or other ocular dye score (positive result ≥ 4 on van Bijsterveld scoring system)
positive biopsy of salivary gland (histopathology)

evidence of salivary gland involvement (positive results on ≥ 1 of the following)
unstimulated whole salivary flow collection (< 1.5 mL in 15 minutes)
parotid sialography with evidence of diffuse sialectasia
salivary scintigraphy with delayed uptake, reduced concentration, and delayed excretion of tracer

antibodies to anti-SS-A and anti-SS-B antigens on serology

Question 22

What is sicca

Answer 22

Sjögren’s syndrome