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Intro > MS-Osteoarthritis versus Rheumatoid Arthritis > Flashcards

MS-Osteoarthritis versus Rheumatoid Arthritis Flashcards

1
Q

What is osteoarthritis?

A

Osteoarthritis is a chronic long-term degenerative disease that causes the breakdown of cartilage in the joints leading to pain and stiffness

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2
Q

What are four essential things to understand about osteoarthritis?

A
  1. A degenerative disorder with minimal articular inflammation
  2. No systemic symptoms
  3. Pain relieved by rest; morning stiffness brief
  4. Radiographic findings: narrowed joint space, osteophytes
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3
Q

What is classified as Primary Osteoarthritis?

A

Arthritis with and unknown cause that is associated with aging; “wear and tear” arthritis

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4
Q

What is classified as Secondary Osteoarthritis?

A

Arthritis that has a known cause

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5
Q

What are some causes of secondary osteoarthritis?

A

Repetitive trauma, obesity, crystal deposits, infection, congenital abnormalities, injury, joint surgery

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6
Q

Does osteoarthritis primarily effect men or women?

A

Before the age of 45 - men; After the age of 55 - women

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7
Q

How many people suffer from osteoartritis?

A

Over 60 - 50%; over 75 - 100%

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8
Q

Which joint is most commonly effected by osteoarthritis?

A

MCP of thumb

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9
Q

Which joints are ALSO commonly effected by osteoarthritis?

A

DIPs and PIPs of other fingers, cervical and lumbar spines, weight bearing joints (hips and knees)

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10
Q

What are the signs and symptoms of osteoarthritis?

A

Pain, stiffness, swelling, deformity, crepitus

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11
Q

What is the most common symptom of osteoarthritis?

A

Pain that increases with joint use and can restrict mobility

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12
Q

How does stiffness typically present in osteoarthritis?

A

It is typically noticed first thing in the morning and after resting; last less than 15 minutes

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13
Q

How do deformities present in osteoarthritis?

A

painless, irregular bony enlargements; Heberden’s and Bouchard’s nodes

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14
Q

Where are Heberden’s nodes found?

A

DIP

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15
Q

Where are Bouchard’s nodes found

A

PIP

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16
Q

What is Crepitis?

A

Grating sound or sensation produced by friction between bone and cartilage

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17
Q

What are the risk factors for osteoarthritis?

A

Obesity, Trauma, Genetics, Age >40, Repetitive movements (sports or employment)

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18
Q

What acronym is used to describe radiographic findings of osteoporosis?

A

LOSS

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19
Q

What does the L in LOSS stand for?

A

Loss of joint space

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20
Q

What does the O in LOSS stand for?

A

Osteophytes - spurs of bone

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21
Q

What does the first S in LOSS stand for?

A

Subarticular sclerosis; increased density of bone on joint line

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22
Q

What does the second S in LOSS stand for?

A

Subchondral cysts; small fluid filled holes in bone on the joint line

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23
Q

What labs should be done for osteoarthritis?

A

None

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24
Q

What medical treatment is recommended for osteoarthritis?

A

Acetaminophen, NSAIDs, Intra-articular injections

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25
Q

What does an intra-articular injection for osteoarthritis consist of?

A

Long term corticosteroid (triamcinolone) with instant relief from lidocaine

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26
Q

What is the surgical intervention for osteoarthritis called?

A

Joint arthroplasty

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27
Q

When is a joint arthroplasty a good option for osteoarthritis treatment?

A

When walking is severely restricted or there is pain when resting or sleeping at night

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28
Q

Is there a cure for osteoarthritis?

A

No

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29
Q

What is the goal of osteoarthritis treatment?

A

Manage pain, minimize disability, maintain quality of life

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30
Q

What lifestyle element can help osteoarthritis?

A

exercise may increase strength and joint function

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31
Q

What can be an associated manifestation with osteoarthritis

A

Depression especially with chronic pain

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32
Q

*What is rheumatoid arthritis?

A

A chronic, systemic autoimmune inflammatory disease

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33
Q

*What are three characteristics of rheumatoid arthritis?

A

insidious onset, morning stiffness, joint pain

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34
Q

*How does rheumatoid arthritis often present?

A

Symmetric polyarthritis with predilection for small joints of the hands and feet

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35
Q

*What antibodies are present in rheumatoid arthritis and at what prevalence rate?

A

Rheumatoid Factor and Anti-Cyclic Citrullinated Peptides (anti-CCP); 70-80%

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36
Q

*What are the extra-articular manifestations associated with rheumatoid arthritis?

A

subcutaneous nodules, interstitial lung disease, pleural effusion, and pericarditis

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37
Q

What is the most common inflammatory arthropathy?

A

Rheumatoid arthitis

38
Q

When is the typical onset of rheumatoid arthritis?

A

4th or 5th decade

39
Q

Is rheumatoid arthritis more common in males or females and at what ratio?

A

Female; 3:1

40
Q

What kind of disease is rheumatoid arthritis?

A

autoimmune disease

41
Q

What are the causes of rheumatoid arthritis?

A

multifactorial; Genetics and Environmental

42
Q

What is an environmental cause of rheumatoid arthritis?

A

tobacco; can both trigger and exacerbate

43
Q

What is the genetic cause of rheumatoid arthritis?

A

HLA DR beta 1 alleles; strong familial relationship associated with RA

44
Q

Describe the inflammatory response of rheumatoid arthritis

A

chronic inflammation of the synovium (synovitis) erodes cartilage, bone, ligaments, and tendon

45
Q

Does rheumatoid arthritis attack bones?

A

No; it disrupts the structures that hold bones together

46
Q

Can rheumatoid arthritis become severe?

A

Yes; it can become unabated and disability can become pronounced

47
Q

What are full body symptoms of rheumatoid arthritis?

A

Weight loss, fatigue, muscle weakness, vague m/s discomfort that eventually settles in joints

48
Q

Is rheumatoid arthritis a constant condition?

A

There are typically various effected joints with flares, followed by asymptomatic periods

49
Q

How long does morning stiffness last with rheumatoid arthritis?

A

about 1 hour

50
Q

What are the most commonly effected joints of rheumatoid arthritis (in order)

A

PIPs of fingers, MCPs, Wrists, Knees, Ankles, MTPs

51
Q

What are the four types of exam findings for rheumatoid arthritis?

A

Joint findings, Rheumatoid nodules, Ocular symptoms, Systemic disease

52
Q

What are common joint findings for rheumatoid arthritis?

A

Polyarticular joint edema, erythema, and pain, often at rest; swan-neck deformities, boutonniere deformities, and ulnar deviation at MCPs

53
Q

Describe rheumatoid nodules

A

Present in 20% of patients; most commonly situated over bony prominences but also observed in the bursae and tendon sheaths

54
Q

Describe ocular symptoms of rheumatoid arthritis

A

Dryness of mouth, eyes, and other mucous membranes; more common in advanced disease

55
Q

Describe systemic disease associated with rheumatoid arthritis

A

Interstitial lung disease (less effective gas exchange); Pericarditis (inflammation around the heart); Disease of lung pleura (wrapping around lung pleura)

56
Q

What is important to note with rheumatoid arthritis?

A

The immune system attacks more than just the joints, so it is necessary to be concerned with systemic manifestations as well

57
Q

What labs are important for the diagnosis of rheumatoid arthritis?

A

Anti-cyclic citrullinated peptide (anti-CCP) and Rheumatoid Factor blood tests

58
Q

Which blood test is the best test for rheumatoid arthritis?

A

Anti-cyclic citrullinated peptide (anti-CCP)

59
Q

Which blood test shows best during a flare of rheumatoid arthritis?

A

Rheumatoid factor

60
Q

How much can aggressive rheumatoid arthritis shorten the life by?

A

10-15 years

61
Q

What might be an option for a healthcare provider to do with a patient suffering from rheumatoid arthritis?

A

refer patient to a rheumatologist to potentially start early aggressive therapy

62
Q

What are primary objectives in treating rheumatoid arthritis?

A

Reduction of inflammation and pain, preservation of function, and prevention of deformity

63
Q

What is the benefit of early recognition and diagnosis of RA?

A

Allows intervention with appropriate medications with a decrease in the destructive arthropathy than can occur with the disorder

64
Q

What should happen if medications do not achieve the target of remission of symptoms or low disease activity of RA?

A

Additional medications should be added to the therapeutic regimen

65
Q

What is a risk factor of immunosuppressive agents?

A

increases a patient’s risk of infection including Hepatitis B and Hepatitis C; they become IMMUNOCOMPROMISED

66
Q

What are the options for pharmacological treatment for rheumatoid arthritis?

A

Low-dose corticosteroids and disease-modifying antirheumatic drugs

67
Q

What is an example of a low-dose corticosteroid?

A

prednisone

68
Q

How do low-dose corticosteroids help treat rheumatoid arthritis?

A

they produce a prompt anti-inflammatory effect and slow the rate of articular erosions

69
Q

Should low-dose corticosteroids be used all the time?

A

No; only use for short term control for patients with “flares”

70
Q

What are two DMARDs?

A

sulfasalazine and methotrexate

71
Q

What type of patient is sulfasalazine particularly good for?

A

Women with potential to become pregnant that are suffering from rheumatoid arthritis

72
Q

What organ are rheumatoid arthritis medications specifically damaging to?

A

the liver

73
Q

What are important tests to obtain before onset of RA medication? How often should it be repeated?

A

Pregnancy test and liver function test; every 3 months after or any time the dose is increased (only LFT)

74
Q

What is known as a long standing medication used to treat rheumatoid arthritis?

A

methotrexate

75
Q

What does methotrexate specifically do?

A

increases adenosine levels, which promotes an anti-inflammatory state

76
Q

How often is methotrexate taken? By what route?

A

once per week; by mouth or IM injection into thigh

77
Q

What is the adverse effect of methotrexate? What is the solution?

A

impacts body’s folic acid levels via GI tract; Take folic acid supplements

78
Q

What is very important to note about methotrexate?

A

It is teratogenic and contraindicated in pregnancy

79
Q

What is folic acid needed for in pregnancy?

A

CNS development

80
Q

What happens if there is a folic acid deficiency in pregnancy?

A

Anencephaly and spina bifida

81
Q

What test should be recommended in addition to routine LFT when taking DMARDs?

A

pregnancy test

82
Q

What is recommended to avoid when taking DMARDs?

A

alcohol

83
Q

What is the newest class of DMARDs used to treat rheumatoid arthritis?

A

Biological response modifiers

84
Q

What is special about biological response modifiers?

A

They are genetically engineered to act like natural proteins in the patient’s immune system

85
Q

Do biological response modifiers cure RA?

A

No, but they can dramatically slow its process

86
Q

What are the 3 biological response modifiers (both brand and generic names)?

A

Etanercept - Enbrel
Adalimumab - Humira
Infliximab - Remicade

87
Q

How are biological response modifiers taken?

A

injected

88
Q

What are the three biological response modifiers known as?

A

tumor necrosis factor blockers

89
Q

What do tumor necrosis factor blockers do?

A

block the action of TNF that leads to damage from abnormal inflammation

90
Q

What are the adverse effects of TNFs/biological response modifiers?

A

increase risk of serious infection such as tuberculosis, herpes zoster, and fungal infections

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