Arthritis Flashcards
how is a joint affected in RA
Tendon sheath becomes inflamed
The synovial membrane becomes inflamed - releases bad cytokines into synovial fluid which eats at bone and cartilage
what does the synovium in RA contain and what does the membrane do
macrophages, fibroblasts, and multi-nucleated giant cells
membrane expands, actively invades and erodes surrounding bone and cartilage
symptoms of RA
Joint pain Stiffness - esp in morning, typically lasts 30 + mins Joint swelling - stiff + tender Reduced range of movement Malaise/fatigue
what is Felty’s syndrome
Triad:
RA
splenomegaly
neutropenia
what are extra articular manifestations of RA
Eye - dry eye, inflammation
Lung - pulmonary fibrosis, pleural effusions, interstitial lung disease
Rheumatic nodules
Antibodies associated with RA
Anti CCP and Rheumatoid factor (RF)
except for antibodies what other investigations can be done in RA
Inflammatory markers - PV, CRP
Ultrasound
complications of RA
infection
cervical myelopathy
interstitial lung disease
peripheral neuropathy
what are poor prognostic indicators for RA
male HLA DR4 positive many active joints high CRP/PV RhF/CCP positive
Tx of RA
DMARD
with NSAIDs and Steroids as adjunctions
features of DMARDS
slow acting - weeks to months
reduce rate of joint damage
initiate as soon as possible
how is the slow acting feature of DMARD dealt with
lag phase is covered with steroid treatment
examples of DMARDs
Methotrexate Sulfasalazine Leflunamide Hydroxychloroquine Pencillamine Gold
if DMARDs do not work, what is next in treatment of RA
Biologic agents
what are examples of biologic agents
TNF inhibition - Inflximab B cell depletion - Rituximab Disruption of T cell co-stimulation - Abatacept Interleukin 1 inhibition - Anankira Interleukin 6 inhibition - Tocilizumab
X-ray signs of OA
LOSS Loss of joint space Osteophytes Subchondral sclerosis Subchondral cyst formation
what type of collagen fibres does cartilage consist of
Collagen type 2
what forms the matrix of the cartilage
Chondrocytes
what happens in OA
loss of matrix, release of cytokines by the chondrocytes.
Fibrillation of the cartilage surface and attempted repair with osteophyte formation then occurs.
what are the types of OA
Idiopathic - either localised (hands/feet/knee/hip) or generalised (3+ sites)
Secondary - previous injury, RA, Acromegaly
Risk factors for OA
Age Female Obesity Lack of osteoporosis Occupation Previous injury
symptoms of OA
Pain - worse on activity, relieved by rest. can progress to being painful at rest
Stiffness - morning stiffness, lasts less than 30 mins
what is seen on examination of OA
Crepitus - due to bone rubbing against bone
Swelling - bony enlargements due to osteophytes
Joint tenderness
Joint effusion
what are bony enlargements at DIPs called
Heberdens Nodes
what are bony enlargements at PIPs called
Bouchards nodes
what complications can OA cause at the knee
Genu varus and valgus deformities
Bakers cysts
where can hip pain radiate to
groin
knee
lower back
complications of OA at the spine
Cervical - pain + ROM. Osteophytes may impinge nerve roots
Lumbar - osteophytes can cause spinal stenosis
pharmacologic management of OA
Analgesia - paracetamol
NSAIDs
Local analgesia - topical creams
what are intra-articular managements of OA
Steroids
Hyaluronic acid
surgical management of OA
Arthroscopic washout
Joint replacement
