MS-Osteoarthritis versus Rheumatoid Arthritis Flashcards
What is osteoarthritis?
Osteoarthritis is a chronic long-term degenerative disease that causes the breakdown of cartilage in the joints leading to pain and stiffness
What are four essential things to understand about osteoarthritis?
- A degenerative disorder with minimal articular inflammation
- No systemic symptoms
- Pain relieved by rest; morning stiffness brief
- Radiographic findings: narrowed joint space, osteophytes
What is classified as Primary Osteoarthritis?
Arthritis with and unknown cause that is associated with aging; “wear and tear” arthritis
What is classified as Secondary Osteoarthritis?
Arthritis that has a known cause
What are some causes of secondary osteoarthritis?
Repetitive trauma, obesity, crystal deposits, infection, congenital abnormalities, injury, joint surgery
Does osteoarthritis primarily effect men or women?
Before the age of 45 - men; After the age of 55 - women
How many people suffer from osteoartritis?
Over 60 - 50%; over 75 - 100%
Which joint is most commonly effected by osteoarthritis?
MCP of thumb
Which joints are ALSO commonly effected by osteoarthritis?
DIPs and PIPs of other fingers, cervical and lumbar spines, weight bearing joints (hips and knees)
What are the signs and symptoms of osteoarthritis?
Pain, stiffness, swelling, deformity, crepitus
What is the most common symptom of osteoarthritis?
Pain that increases with joint use and can restrict mobility
How does stiffness typically present in osteoarthritis?
It is typically noticed first thing in the morning and after resting; last less than 15 minutes
How do deformities present in osteoarthritis?
painless, irregular bony enlargements; Heberden’s and Bouchard’s nodes
Where are Heberden’s nodes found?
DIP
Where are Bouchard’s nodes found
PIP
What is Crepitis?
Grating sound or sensation produced by friction between bone and cartilage
What are the risk factors for osteoarthritis?
Obesity, Trauma, Genetics, Age >40, Repetitive movements (sports or employment)
What acronym is used to describe radiographic findings of osteoporosis?
LOSS
What does the L in LOSS stand for?
Loss of joint space
What does the O in LOSS stand for?
Osteophytes - spurs of bone
What does the first S in LOSS stand for?
Subarticular sclerosis; increased density of bone on joint line
What does the second S in LOSS stand for?
Subchondral cysts; small fluid filled holes in bone on the joint line
What labs should be done for osteoarthritis?
None
What medical treatment is recommended for osteoarthritis?
Acetaminophen, NSAIDs, Intra-articular injections
What does an intra-articular injection for osteoarthritis consist of?
Long term corticosteroid (triamcinolone) with instant relief from lidocaine
What is the surgical intervention for osteoarthritis called?
Joint arthroplasty
When is a joint arthroplasty a good option for osteoarthritis treatment?
When walking is severely restricted or there is pain when resting or sleeping at night
Is there a cure for osteoarthritis?
No
What is the goal of osteoarthritis treatment?
Manage pain, minimize disability, maintain quality of life
What lifestyle element can help osteoarthritis?
exercise may increase strength and joint function
What can be an associated manifestation with osteoarthritis
Depression especially with chronic pain
*What is rheumatoid arthritis?
A chronic, systemic autoimmune inflammatory disease
*What are three characteristics of rheumatoid arthritis?
insidious onset, morning stiffness, joint pain
*How does rheumatoid arthritis often present?
Symmetric polyarthritis with predilection for small joints of the hands and feet
*What antibodies are present in rheumatoid arthritis and at what prevalence rate?
Rheumatoid Factor and Anti-Cyclic Citrullinated Peptides (anti-CCP); 70-80%
*What are the extra-articular manifestations associated with rheumatoid arthritis?
subcutaneous nodules, interstitial lung disease, pleural effusion, and pericarditis
What is the most common inflammatory arthropathy?
Rheumatoid arthitis
When is the typical onset of rheumatoid arthritis?
4th or 5th decade
Is rheumatoid arthritis more common in males or females and at what ratio?
Female; 3:1
What kind of disease is rheumatoid arthritis?
autoimmune disease
What are the causes of rheumatoid arthritis?
multifactorial; Genetics and Environmental
What is an environmental cause of rheumatoid arthritis?
tobacco; can both trigger and exacerbate
What is the genetic cause of rheumatoid arthritis?
HLA DR beta 1 alleles; strong familial relationship associated with RA
Describe the inflammatory response of rheumatoid arthritis
chronic inflammation of the synovium (synovitis) erodes cartilage, bone, ligaments, and tendon
Does rheumatoid arthritis attack bones?
No; it disrupts the structures that hold bones together
Can rheumatoid arthritis become severe?
Yes; it can become unabated and disability can become pronounced
What are full body symptoms of rheumatoid arthritis?
Weight loss, fatigue, muscle weakness, vague m/s discomfort that eventually settles in joints
Is rheumatoid arthritis a constant condition?
There are typically various effected joints with flares, followed by asymptomatic periods
How long does morning stiffness last with rheumatoid arthritis?
about 1 hour
What are the most commonly effected joints of rheumatoid arthritis (in order)
PIPs of fingers, MCPs, Wrists, Knees, Ankles, MTPs
What are the four types of exam findings for rheumatoid arthritis?
Joint findings, Rheumatoid nodules, Ocular symptoms, Systemic disease
What are common joint findings for rheumatoid arthritis?
Polyarticular joint edema, erythema, and pain, often at rest; swan-neck deformities, boutonniere deformities, and ulnar deviation at MCPs
Describe rheumatoid nodules
Present in 20% of patients; most commonly situated over bony prominences but also observed in the bursae and tendon sheaths
Describe ocular symptoms of rheumatoid arthritis
Dryness of mouth, eyes, and other mucous membranes; more common in advanced disease
Describe systemic disease associated with rheumatoid arthritis
Interstitial lung disease (less effective gas exchange); Pericarditis (inflammation around the heart); Disease of lung pleura (wrapping around lung pleura)
What is important to note with rheumatoid arthritis?
The immune system attacks more than just the joints, so it is necessary to be concerned with systemic manifestations as well
What labs are important for the diagnosis of rheumatoid arthritis?
Anti-cyclic citrullinated peptide (anti-CCP) and Rheumatoid Factor blood tests
Which blood test is the best test for rheumatoid arthritis?
Anti-cyclic citrullinated peptide (anti-CCP)
Which blood test shows best during a flare of rheumatoid arthritis?
Rheumatoid factor
How much can aggressive rheumatoid arthritis shorten the life by?
10-15 years
What might be an option for a healthcare provider to do with a patient suffering from rheumatoid arthritis?
refer patient to a rheumatologist to potentially start early aggressive therapy
What are primary objectives in treating rheumatoid arthritis?
Reduction of inflammation and pain, preservation of function, and prevention of deformity
What is the benefit of early recognition and diagnosis of RA?
Allows intervention with appropriate medications with a decrease in the destructive arthropathy than can occur with the disorder
What should happen if medications do not achieve the target of remission of symptoms or low disease activity of RA?
Additional medications should be added to the therapeutic regimen
What is a risk factor of immunosuppressive agents?
increases a patient’s risk of infection including Hepatitis B and Hepatitis C; they become IMMUNOCOMPROMISED
What are the options for pharmacological treatment for rheumatoid arthritis?
Low-dose corticosteroids and disease-modifying antirheumatic drugs
What is an example of a low-dose corticosteroid?
prednisone
How do low-dose corticosteroids help treat rheumatoid arthritis?
they produce a prompt anti-inflammatory effect and slow the rate of articular erosions
Should low-dose corticosteroids be used all the time?
No; only use for short term control for patients with “flares”
What are two DMARDs?
sulfasalazine and methotrexate
What type of patient is sulfasalazine particularly good for?
Women with potential to become pregnant that are suffering from rheumatoid arthritis
What organ are rheumatoid arthritis medications specifically damaging to?
the liver
What are important tests to obtain before onset of RA medication? How often should it be repeated?
Pregnancy test and liver function test; every 3 months after or any time the dose is increased (only LFT)
What is known as a long standing medication used to treat rheumatoid arthritis?
methotrexate
What does methotrexate specifically do?
increases adenosine levels, which promotes an anti-inflammatory state
How often is methotrexate taken? By what route?
once per week; by mouth or IM injection into thigh
What is the adverse effect of methotrexate? What is the solution?
impacts body’s folic acid levels via GI tract; Take folic acid supplements
What is very important to note about methotrexate?
It is teratogenic and contraindicated in pregnancy
What is folic acid needed for in pregnancy?
CNS development
What happens if there is a folic acid deficiency in pregnancy?
Anencephaly and spina bifida
What test should be recommended in addition to routine LFT when taking DMARDs?
pregnancy test
What is recommended to avoid when taking DMARDs?
alcohol
What is the newest class of DMARDs used to treat rheumatoid arthritis?
Biological response modifiers
What is special about biological response modifiers?
They are genetically engineered to act like natural proteins in the patient’s immune system
Do biological response modifiers cure RA?
No, but they can dramatically slow its process
What are the 3 biological response modifiers (both brand and generic names)?
Etanercept - Enbrel
Adalimumab - Humira
Infliximab - Remicade
How are biological response modifiers taken?
injected
What are the three biological response modifiers known as?
tumor necrosis factor blockers
What do tumor necrosis factor blockers do?
block the action of TNF that leads to damage from abnormal inflammation
What are the adverse effects of TNFs/biological response modifiers?
increase risk of serious infection such as tuberculosis, herpes zoster, and fungal infections
