Arthritis Flashcards
Define osteoarthritis.
non-inflammatory disorder of moveable joints due to loss/damage of articular cartilage and a decreased joint space due to new bone formation on the joint surfaces
Likely causes of OA?
- increased age
- trauma - fractures, joint instability
- deformity - congenital
- occupation - sports people, builders
- obesity!
Clinical features of OA
- NO systemic factors
- pain - insidious onset, relieved by rest aggravated by activity
- swelling - intermittent or continuous
- stiffness - worse after long rest (waking) but doesn’t last as long as RA stiffness
Signs on examination of OA.
-heberdens + bouchards nodes (palpable osteophytes)
(heberdens is distal - think outer hebredies)
-swelling
-muscle wasting
-deformity
-decreased ROM
-crepitus
diagnostics for OA.
- XRAY - most joints
- CT - foot, ankle, hand, spine - because can be difficult on XR
- bloods - negative RA screen
- diagnostic steroid injection - if it works.. its OA
- arthroscopy
Xray findings for O
LOSS
- loss of joint space
- osteophytes
- subchondral cysts
- subarticular sclerosis
3 principles of OA management?
- conservative - decrease load (weight loss), relieve pain(NSAIDS - tablet/topical), increase movement (physio)
- injection - steroids
- surgery - remove pain, improve function, correct deformity
What are the surgical options of OA?
- joint debridement
- joint excision
- joint fusion
- joint replacement (arthoplasty)
FU clinic 2 months - 6/52 stick/crutches w/ physio.
Tell me about hip OA.
- RF - woman, increased age, obesity, DDH
- Sx - groin ache post exercise relieved by rest
- Red flag - night pain, rest pain, >2hrs morning stiffness
- Oxford hip pain scoring system
Complications of a hip replacement, acute + chronic plz?
acute - VTE, intraoperative fracture, nerve damage
chronic - aseptic loosening, pain, dislocation, infection
Define RA.
- A chronic autoimmune inflammatory disease affecting the joints symmetrically - SYNOVIAL joints
- affects women more than men (3x pre-menopausal), 40-50 onset.
What are some risk factors of RA?
- SMOKING
- genes and FH
- gender -woman
- defective cell meditated immunity
what is rheumatoid factor? what is the % of RA patients it’s present in?
- auto-antibody against IgG therefore effecting ones immunity
- 80% but still not specific for RA
What’s the presentation of RA?
- SYSTEMIC FEATURES - fatigue + malaise, fever, weight loss
- symmetrical joint disease mainly affecting the hands and feet (>80%)
- pain + swelling
- early morning stiffness lasting longer than 30 mins
- larger joints affected later in disease causes (all can be apart from L spine)
- POSITIVE MCP SQUEEZE TEST
What are some extra-articular manifestations of RA?
- lungs - pleural effusion, Rhem nodules, fibrosis
- heart - pericardial effusion
- vascular - leg ulcers, raynauds
- eyes - dryness, scleritis, episcleritis, ulceration
- neuro - mild peripheral neuropathy, myelopathy
- kidney - amyloidosis - BAD kills 10% of RA pts
Hand signs for RA?
- Z thumb deformity
- ulnar deviation of fingers
- swan neck deformity
- wrist subluxation
- NODULES ON ELBOWS - examination.. do it
What’s the most useful blood test in RA?
-anti-CCP
bloods for RA?
- FBC - normocytic, normochromic anaemia
- anti-CCP (cyclic citrullinated peptide)
- Rheum factor
- increase CRP ESR
Xray findings for RA?
LOJJ loss of joint space Oedema of the soft tissue juxta-articular osteopenia joint deformity
GP management of suspected RA?
- 2 week referral to early arthritis clinic to prevent joint deformity
- analgesia to cover them in the meantime
Management of RA?
- no cure but induce remission and return to normal functioning
- DMARDS + corticosteroids to induce remission
- MTX most frequently used
- other = azathioprine, sulfasalazine, hydroxychloroquine
What are the monitoring requirement for methotrexate? Tell me why though?
- FBC & LFTs
- myelosuppression
- liver cirrhosis
What are the indications for TNF inhibitors in RA? give me some examples of them too please.
- failure to control disease with a least 2 different DMARDS
- infliximab, enteracept, adalimumab
Give some info about juvenile idiopathic arthritis.
- joint pain/swelling/stiffness >6/52
- <16 years old
- no other causes
- 7 subtypes dependent on presentation
How does one monitor RA’s response to treatment?
- CRP
- DAS - disease activity scoring
