Comparison of degenerative vs inflammatory disease Flashcards
How does the morning stiffness differ between OA and RA
Lasts <30 minutes with OA but >30 minutes with RA
What happens to the joints in OA and RA
OA= cartilage loss RA= inflammed synovium
Which of OA and RA is symmetrical
RA symmetrical, OA asymmetrical
Describe the onset of RA vs OA
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
Describe how joints feel in RA vs OA
RA= joints are painful, swollen and stiff OA= joints are achy and tender, but show little or no swelling
Describe the pattern of affected joints in OA vs RA
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
What full body symptoms are present in OA and RA
RA- frequent fatigue and general feeling of being ill
OA- no whole body symptoms
OA of the hips is uncommon in what ethnicity
Africans and asians
Polyarticular OA of the hands is rare in what ethnicities
Malaysians and africans
Name some OA individual risk factors
Obesity
Inherited type 2 collagen defects
Inheritence in nodal and erosive OA
Occupation
What can secondary osteoathritis be due to
- Mechanical incongruity of joint
- Prior inflammatory disease
- Endocrine disorders
- Metabolic disorders
What is OA primarily characterised by
Degeneration of articular cartilage with subsequent changes in the other tissues
What 4 radiological signs are there for OA
Cartilage loss/ joint space narrowing
Osteophytes
Subchondral sclerosis
Subchondral cysts
What is the name of OA that affects DIP
Herberdens node
What is the name of OA that affects PIP
Bouchards node
Does HRT help with symptoms/ progression of nodal generalised OA
No
What is erosive OA
A more inflammatory form of OA, characterised by erosions of cartilage in the DIP and PIP joints
Who is most commonly affected by erosive OA
Middle aged/ post menopausal women
What muscles cause z-deformity of the thumb seen in rheumatoid arthritis
Flexion of MCP
Extension of IP
What muscles cause swan neck deformity seen in RA
Extension of PIP
Flexion of DIP (4th finger)
What deviations occur in RA
Ulnar deviation of fingers at MCP
Radial devication of wrist
Why does dorsal subluxation of ulnar occur in RA
Due to interruption of radioulnar ligament
What autoantibodies are seen in RA
IgM to Fc portion of IgG
Anti-citrullinated peptide antibodies
In what % of RA cases are rheumatoid factor IgM to Fc portion of IgG seen
60-80%
In what % of RA are anti-citrullinated peptide antibodies seen
96% specific to RA
What is the action of cytokines in RA (2)
1- Proliferation of fibroblasts in subintima and type B synoviocytes
2- Induce synovial fibroblasts to express RANKL and induce osteoclast production
What causes inflammation in RA
Activation of T cells, B cells and macrophages which release cytokines such as IL-1, IL-6 and TNF-alpha causing local joint damage
What molecules leak into the blood stream in RA causing sytemic inflammation
IL-1, IL-6 TNF-alpha
What kind of anaemia often accompanies RA
Hypochromic normocytic anaemia
