Medicine- Osteoarthritis + Rheumatoid Arthritis + GOUT Flashcards
What is Osteoarthritis?
a) Thinning and Weakness of the Bones
b) Cartilage loss and peri-articular bone reaction of the joints
c) Weakening Joints
d) Chronic inflammation mainly affecting joints
b) Cartilage loss and peri-articular bone reaction of the joints
What is the main symptom of OA?
a) Morning Stiffness
b) Swelling of the Joints
c) Immobility
d) Joint Pain
d) Joint Pain
Immobility is important in OA, but is not the main symptom.
Which is a single diagnostic investigation for OA?
a) Bloods
b) X-Ray
c) CT Scan
d) MR
b) X-Ray
RA: Anti-CCP (bloods) OA: X-ray
What is the first line medical treatment for OA?
a) Oral NSAIDS
b) Paracetamolà Acetaminophen
c) Opioids
d) Steroid Injections
b) Paracetamol —> Acetaminophen
What is Osteoarthritis?
Osteoarthritis (OA) is a chronic joint disease caused by the breakdown of joint cartilage and the bone underneath.
OA
Which joints are affected?
• Commonly , the joints affected are those near the ends of the fingers, at the base of the thumb, neck, lower back, knee, and hips. It is a degenerative cause often having minute biological changes
OA
PAtho?
• The collagen matrix becomes more disorganized causing a decrease in proteoglycan content within cartilage
. • The breakdown of collagen fibres results in a net increase in water content leading towards ‘wear and tear’ arthritis.
OQ
symptoms?
• Pain —-> Joint pain associated exacerbated by prolonged activity and relieved following rest.
• Stiffness —-> Morning joint stiffness are often brief lasting less than minutes. The stiffness is often more severe in the morning or following a period of inactivity. Morning stiffness associated with another type of arthritis called ? osteoarthritis usually wears off within 30 minutes.
• Crackling noise &Crepitus when moving a joint.
• Locking Joints
OA
signs?
- Bunions —–> Osteoarthritis on the toes
- Bouchards Nodes ——> Hard bony enlargements on the proximal interphalangeal joints
- Heber dens Node —–> Hard bony enlargements on the distal interphalangeal joints
Epidemiology for OA
- 3-6% of the general population will be affected by osteoarthritis
- By the age of 55, 15% will have symptomatic osteoarthritis of the knee
- Woman are at a higher risk of having severe arteritis compared to men
Ix for OA
ØJoint space narrowing
ØSubchondrial Sclerosis (Thickening of the joint bones) seen by a whiter (denser) section of the bone.
ØSubchondrial cyst formation: A fluid filled sac within the joint medium.
ØOsteophytes: Bony projections associated with cartilage joint degeneration.
Differential diagnosis for OA
and how to differentiate them?
Management for OA?
• Non-Pharmacological Strategies : Exercise to strengthen the surrounding ligaments; weight loss(especially if they are overweight)à to reduce the pressure on the joints and education (to avoid further damage)
• Paracetamol/NSAIDS : Can help mask the pain including medications like Paracetamol/Naproxen
• Analgesic: Opioids such as Tramadol may be administered if the chronic pain persists
• Glucosamine/ Chondroitin: May reduce the pain and improve the mobility of the joint (Although this is still under review)
• Surgery: Is a final option in some cases to replace the full joint in severe cases.
OSCE tips for OA
A 30-year-old woman is morbidly obese. Which joints are most likely to have early degenerative changes?
a) Hip and Ankles
b) Knees and Ankles
c) Hips and Knees
d) Lumbar spine and ankles
c) Hips and Knees
A 38-year-old male accountant complains of hand pain. A radiograph is notable for degenerative changes in the second and third metacarpal phalangeal joints. Which is the most helpful in diagnosis?
a) ESR b) Ferritin c) RF d) Anti-Nuclear Antibody
b) Ferritin
Laboratory tests in patients with osteoarthritis are generally normal, including the ESR.
Characteristic radiographic findings in osteoarthritis include all of the following EXCEPT:
a) Osteophytes
b) Symmetrical Joint narrowing
c) Subchondral Cysts
d) Subluxation
e) Subchondral Bone Sclerosis
b) Symmetrical Joint narrowing
Osteoarthritis can be thought of as a localized process in which mechanical forces are distributed in an unequal fashion over the joint surface, resulting in asymmetrical joint space narrowing
What Exactly is Rheumatoid Arthritis?
a) Weakening of the Joints
b) Thinning & Weakness of the Bones
c) Calcium pyrophosphate deposition in the joints
d) Chronic inflammation mainly affecting the joints
d) Chronic inflammation mainly affecting the joints
What are the classical symptoms of RA?
a) Morning Stiffness
b) Swelling of the Joints
c) Pain
d) Poor range of joint movements
ALL
Which single diagnostic marker is most specific for RA?
a) CRP
b) Anti-CCP
c) Rheumatoid Factor
d) Creatinine Kinase
b) Anti-CCP
Which medication targets the immune system and slows the progression of the disease preventing joint damage?
a) NSAIDS
b) Paracetamol/Painkillers
c) DMARDS
d) Biological Response Factorsd) Biological Response Factors
What is Rheumatoid Arthritis?
- Rheumatoid arthritis is a long-term, progressive, inflammatory condition that causes pain, swelling and stiffness in the joints.
- It is an autoimmune disease where the joints are mistakenly attacked by the body’s own immune system.
RA
are joints bilaterally or unilaterally?
The joints are often bilaterally affected where the hands, feet and wrists are often susceptible to injury.
What are symptoms of RA
RA
Sign
Epidemiology for RA
- Age range —-> Common between the age range of 30 to 55 years.
- Well recognized in children and adults
- Common in females (3:1) compared to males where males often experience initial symptoms later in comparison to females.
Ix for RA
Differentials for RA
Management for RA
OSCE tips for RA
- Be very critical when taking the history and relate your questions to the American College of Rheumatology.
- Be observant when inspecting the joints. Is it swollen, deformed, wasted, warm or red? Check the patients temperature (often forgotten).
- Ask about distribution and timing as referred shoulder pain may present as cervical spondylosis.
- Various medications including hydralazine are potential causes of joint issues.
Rheumatoid arthritis (RA) is different from some other forms of arthritis because it…
a) Its more painful than others
b) Occurs below the waist
c) Symmetrical
d) Occurs above the waist
c) Symmetrical
Rheumatoid arthritis (RA) differs from some other forms of arthritis because it is symmetrical, affecting both sides of the body. Other types of arthritis, such as osteoarthritis, may affect only one side of the body
RA is more severe in..
a) Men b) Women c) Children d) Kangaroos
b) Women
RA tends to affect three times as many women as men, and symptoms may be more severe in women as well. RA tends to affect women at earlier ages, and men seem to have more cases of remission of the disease
Rheumatoid arthritis can be cured if diagnosed and treated early
a) True b) False c) Unsure d) All the above
b) False
Treatment for RA that is started early on in the disease process can help minimize or slow damage to the joints and impr
What Exactly is Gout?
a) Swelling of the joint due to a deposition of calcium pyrophosphate.
b) Swelling of the joint due to a deposition of uric acid crystals in the synovium.
c) Inflammation of the joint due to an infection
d) Chronic inflammation mainly affecting joints
b) Swelling of the joint due to a deposition of uric acid crystals in the synovium.
Which part of the body is most commonly affected?
a) Distal Phalangeal Joint b
) Wrist
c) First Metatarsal Phalangeal
d) Proximal Phalangeal Joint
c) First Metatarsal Phalangeal
Which is a clinical feature of Gout?
a) Tophi
b) Swans –Neck Deformity
c) Bouchards Nodes
d) Heberdens’ Nodes
a) Tophi
A tophus is a deposit of uric acid crystals, in the form of monosodium urate crystals, in people with longstanding hyperuricemia
Which method is used to diagnose Gout?
a) Clinical Examination
b) Bloods
c) X-ray
d) Aspiration
ALL
What is Gout?
- Inflammatory arteritis presenting with recurrent attacks of red, hot and swollen joints
- Pain is often acute and can have a duration up to 12 hours
The joint of the big tow is commonly affected and may result in _____ _______ ____ _______ ______
The joint of the big tow is commonly affected and may result in tophi/kidney stones and urate nephropathy.
How is gout diagnosed?
• Gout is clinically diagnosed as having persistent high serum levels of uric acids which can consequently result in crystallised deposits in joints and tendons.
Symptoms of gout?
- Pain —–> Joint pain associated with inflammation, discomfort and redness
- Fatigue
- Fever
- Acute —-> CAN suddenly become symmptomatic without previous warning
- Flank pain —-> From urate neuropathy
Epidemiology of gout?
- Acute attacks occurs in around 1.25 per1000 of adults.
- Factors affecting gout include: age, race, season of the year.
- Rates are 2% in males over 30 and females over 50 years of age.
- More commonly effects the white population
- Risk factors include previous episodes of gout, age, race, and the season of the year.
Ix for gout?
Differentials for Gout?
• Septic Arteritis —> Should be considered if symptoms do not improve with treatment. Other symptoms include: fever, weakness and headaches. Occasionally more then 1 joint is affected.
• Pseudogout —> Having calcium pyrophosphate deposits in the joint instead. Often affecting more than 1 joint and is often associated with osteoarthritis.
• Rheumatoid Arteritis —> A long term autoimmune disorder clinically having stiffness in the morning and worsens following rest
• Psoriatic Arthritis —> Also autoimmune having swelling of the entire fingers and toes ‘sausage like appearance’. Often associated with changes in the nails as well.
• Reactive Arteritis —> Reiter’s Syndrome : Can’t see, pee or climb a tree
Management for gout?
- NSAIDS —> First line of treatment dealing with acute episodes.
- Lifestyle Management —> Weight loss/ Reduced alcohol intake all help reduce uric acid levels and its deposition in the joints. This helps reduce recurrent flare ups.
- Allopurinol —> A medication used to reduce serum uric acid levels by blocking xanthine oxidase. It is a prevention mechanism.
- Glucocorticoids —> Found to be just as effective as steroids but ruling out a joint infection is essential before injection.
OSCE Tips for Gout
You may be able to tell when a gout attack is coming by:
a) Tingling feet in the toe
b) Itching of the fingers
c) Redness in the fingers and toes
d) Joint Crepitation
a) Tingling feet in the toe
Can Gout be diagnosed by a single blood test?
a) Yes b) No
b) No
A blood test can measure your uric acid level, but that’s not enough to diagnose gout. Even people without gout can have high uric acid
Can aspirin help ease gout?
a) Yes b) No
b) No
When you have a gout attack, an NSAID like ibuprofen might help with the pain. However, Aspirin can cause the uric acid levels to increase, which can bring on a gout flare or make a flare worse.
