Cortext: Artritis

Question 1

What is the most common form of arthritis?

Answer 1

OA

Question 2

What causes the periodic flaring of symptoms in OA?

Answer 2

Associated inflammation with the OA

Question 3

List some causes of secondary OA:

Answer 3

Congenital dislocation of the hip

Perthes

SUFE

Previous intra‐articular fracture

Extra‐articular fracture with malunion

Osteochondral / hyaline cartilage injury

Crystal arthropathy

Inflammatory arthritis (can give rise to mixed pattern arthritis)

Meniscal tears

Genu Varum or Valgum

Question 4

What four signs on x-ray are associated with osteoarthritis?

Answer 4

Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts

(LOSS)

Question 5

Inflammatory arthropathies can be classified in which 4 groups?

Answer 5

Seronegative
Seropositive
Infectious
Crystal deposition disorders

Question 6

What is the mainstay of treatment for inflammatory arthropathies?
(4)

Answer 6

Simple analgesia
Anti‐ inflammatory medications (steroids & NSAIDs)
Steroid injections
Disease Modifying Anti Rheumatic Drugs (DMARDs).

Question 7

Is the pattern of RA symmetrical bilaterally?

Answer 7

Yes

Question 8

Is the pattern of OA symmetrical bilaterally?

Answer 8

Yes

Question 9

Is the pattern of Psoriatic Arthritis symmetrical bilaterally?

Answer 9

No

Question 10

Is the pattern of Inflammatory Spondylitis symmetrical bilaterally?

Answer 10

No,

shoulder, knee etc may be affected as well as back

Question 11

Name some features which are suggested of joint INFLAMMATION:
(6)

Answer 11

Joint pain with associated swelling
Morning stiffness
Improvement in symptoms with exercise
Synovitis on examination
Raised inflammatory markers (CRP and plasma viscosity)
Extra-articular symptoms

Question 12

What type of arthropathy is RA?

Answer 12

Seropositive inflammatory arthropathy

auto‐immune inflammatory symmetric polyarthropathy which most commonly affects the small joints of the hands and feet

Question 13

How prevalent is RA compared to other seropositive inflammatory arthropathies

Answer 13

Rheumatoid arthritis is the most prevalent seropositive inflammatory arthropathy

Question 14

How much more likely are women to be affected by RA than men?

Answer 14

Women are 2‐3 times more commonly affected than men.

Question 15

What is the approximate prevalence rate of RA and at what age does this rate peak?

Answer 15

The prevalence rate is approximately 1%, increasing with age and peaking between the ages of 35 and 50 years.

Question 16

To what extent to genetic factors account for the risk of developing RA?

Answer 16

Genetic factors account for 50% of the risk for developing RA.

First degree relatives of individuals with RA are at 2- to 3-fold higher risk for the disease

Question 17

In the disease process of RA, an immune response is initiated againt what?

Answer 17

The synovium, which lines the synovial joints and some tendons.

(Inflammatory pannus forms which then attacks and denudes articular cartilage leading to joint destruction. Tendon ruptures and soft tissue damage can occur leading to joint instability and subluxation.)

Question 18

What three factors is the diagnosis of RA based upon?

Answer 18

Clinical Presentation
Radiographic finding
Serological analysis

Question 19

Which (2) scoring systems assist in the diagnosis of RA?

Answer 19

The ACR and EULAR Rheumatoid Arthritis Criteria scoring systems.

Question 20

Which clinical features are often present in RA?

Answer 20

Symmetrical synovitis (doughy swelling)
Pain
Morning stiffness

MCP and PIP joints affected, as well as wrists
DIP joints NOT affected

Question 21

What does “synovitis” mean?

Answer 21

Inflammation of synovial membrane

Question 22

What can happen to the joints of the cervical spine in longstanding RA?

Answer 22

In RA, over time, larger joints can be affected.
On important area is the cervical spine,
In longstanding disease, there may be atlanto-axial subluxation which can result in cervical cord compression.
(between C1 and C2)
(C1 - atlas, C2 - axis)
Subluxation here
–> Cervical cord compression

Question 23

Which extra-articular manifestations can be seen in RA?

Answer 23

Rheumatoid nodules
(Occur in approx 25% of patients with RA)
(These lesions are most commonly found on extensor surfaces or sites of frequent mechanical irritation.)

Lung involvement:
Pleural effusions
Interstitial Fibrosis
Pulmonary Nodules

CVS:
Cardiovascular morbidity and mortality increased in patients with RA

Ocular involvement is common in patients with RA, includes:
Keratoconjunctivitis sicca (dry eye)
Episcleritis
Uveitis
Nodular scleritis - that may lead to scleromalacia (degeneration/softening of the sclera)