Comparison of degenerative vs inflammatory disease

Question 1

How does the morning stiffness differ between OA and RA

Answer 1

Lasts <30 minutes with OA but >30 minutes with RA

Question 2

What happens to the joints in OA and RA

Answer 2

OA= cartilage loss
RA= inflammed synovium

Question 3

Which of OA and RA is symmetrical

Answer 3

RA symmetrical, OA asymmetrical

Question 4

Describe the onset of RA vs OA

Answer 4

RA= begins at any time and has relatively rapid onset of weeks to months
OA= begins later in life and onset is slower, over years

Question 5

Describe how joints feel in RA vs OA

Answer 5

RA= joints are painful, swollen and stiff
OA= joints are achy and tender, but show little or no swelling

Question 6

Describe the pattern of affected joints in OA vs RA

Answer 6

RA- affects larger and small joints on both sides (symmetrical)
OA- symptoms begin on one side, begin gradually are often just in one set of joints such as DIP/ PIPs or weight bearing joints

Question 7

What full body symptoms are present in OA and RA

Answer 7

RA- frequent fatigue and general feeling of being ill

OA- no whole body symptoms

Question 8

OA of the hips is uncommon in what ethnicity

Answer 8

Africans and asians

Question 9

Polyarticular OA of the hands is rare in what ethnicities

Answer 9

Malaysians and africans

Question 10

Name some OA individual risk factors

Answer 10

Obesity
Inherited type 2 collagen defects
Inheritence in nodal and erosive OA
Occupation

Question 11

What can secondary osteoathritis be due to

Answer 11

• Mechanical incongruity of joint
• Prior inflammatory disease
• Endocrine disorders
• Metabolic disorders

Question 12

What is OA primarily characterised by

Answer 12

Degeneration of articular cartilage with subsequent changes in the other tissues

Question 13

What 4 radiological signs are there for OA

Answer 13

Cartilage loss/ joint space narrowing
Osteophytes
Subchondral sclerosis
Subchondral cysts

Question 14

What is the name of OA that affects DIP

Answer 14

Herberdens node

Question 15

What is the name of OA that affects PIP

Answer 15

Bouchards node

Question 16

Does HRT help with symptoms/ progression of nodal generalised OA

Answer 16

No

Question 17

What is erosive OA

Answer 17

A more inflammatory form of OA, characterised by erosions of cartilage in the DIP and PIP joints

Question 18

Who is most commonly affected by erosive OA

Answer 18

Middle aged/ post menopausal women

Question 19

What muscles cause z-deformity of the thumb seen in rheumatoid arthritis

Answer 19

Flexion of MCP

Extension of IP

Question 20

What muscles cause swan neck deformity seen in RA

Answer 20

Extension of PIP

Flexion of DIP (4th finger)

Question 21

What deviations occur in RA

Answer 21

Ulnar deviation of fingers at MCP

Radial devication of wrist

Question 22

Why does dorsal subluxation of ulnar occur in RA

Answer 22

Due to interruption of radioulnar ligament

Question 23

What autoantibodies are seen in RA

Answer 23

IgM to Fc portion of IgG

Anti-citrullinated peptide antibodies

Question 24

In what % of RA cases are rheumatoid factor IgM to Fc portion of IgG seen

Answer 24

60-80%

Question 25

In what % of RA are anti-citrullinated peptide antibodies seen

Answer 25

96% specific to RA

Question 26

What is the action of cytokines in RA (2)

Answer 26

1- Proliferation of fibroblasts in subintima and type B synoviocytes
2- Induce synovial fibroblasts to express RANKL and induce osteoclast production

Question 27

What causes inflammation in RA

Answer 27

Activation of T cells, B cells and macrophages which release cytokines such as IL-1, IL-6 and TNF-alpha causing local joint damage

Question 28

What molecules leak into the blood stream in RA causing sytemic inflammation

Answer 28

IL-1, IL-6 TNF-alpha

Question 29

What kind of anaemia often accompanies RA

Answer 29

Hypochromic normocytic anaemia