MS1: RA and OA Flashcards
what is RA ?
a chronic, inflammatory, autoimmune disease that affects the synovium
occurrence of RA
50 yo female
more in women
peak in 4th and 6th decade - 50 yo
increase chance w age
americans - caucasians - black - asian
describe onset of RA
insidous
most common joints affected by RA
wrist, MCP, PIP and MTP
as disease progresses it affects larger - mga knees, elnow and ankle
what is spared in RA
DIP and thoracolumbar
main characteristics of RA
symmetrical joint involvement pf small joints of feet
morning stiffness more than an hour
systemic symptoms
extraarticular manifestations
what are the extraarticular manifestations of RA
rheumatoid nodules
shortness of breath and chest pain - cardiopulmo involvement
orbital redness - scleresis
dry eyes and mouth
hallmark symptom of RA
morning stiffness more than an hour
most common extraarticular manifestation of RA
rheumatoid nodule
common site for rheumatoid nodules
extensor surfaces and areas subjected to mech pressure
occurrence of pleuropulmonary manifestations
more in men - pulmonary fibrosis and nodules
when does scleritis commonly occur
6th decade and more on women
BILAT
if u have scleritis what does it mean
more advanced RA - more extraarticular manifestations
classical criteria for RA
morning stiffness
arthritis of 3 or more joints
arthritis of hand
symmetric
rheumatoid nodules
serum rheumatoid factor
radiographic changes
requirements for classical criteria
score at least 4/7 and 1-4 must last for at least 6 wks
possible areas for arthritis of 3 or more factor
R and L
PIP
MCP
wrist
elbow
knee
ankle
MTP
possible areas for arthritis of hand
wrist, MCP or PIP
modern scoring for RA - joint involvement
1: one large joint
2: 2-10 large joints
3: 1-3 small joints
4: 4-10 small joints
5: > 10 joints
modern scoring for RA - lab studies
0: negative RF + CCP
2: low positive RF + CCP
3: high positive RF + CCP
modern scoring for RA - acute phase reactants
0: normal CRP and ESR
1: abnormal CRP and ESR
modern scoring for RA - duration
0: less than 6 wks
1: more than 6 wks
diagnosis for modern criteria of RA
score 6 or higher
discuss the pathophysiology of RA
inflammation in synovium
pannus forms - grainy tissue that erodes cartilage
tendons get inflamed or rupture = joint fusion
discuss manifestation of RA in cervical spine
atlantoaxial and midcervical
neck stiff and LOM
C1-C2 instability and compression
discuss manifestation of RA in TMJ
limited mouth opening
discuss manifestation of RA in shoulders
LOM - frozen shoulder syndrome or adhesive cap
discuss manifestation of RA in elbow
flexion deformity
ulnar compression
discuss manifestation of RA in wrists
flexion contracture - dec power grasp
radial dev of distal carpals
dequervain’s
discuss manifestation of RA in hand
boutonniere of thumb
ulnar dev of MCP
swan neck
piano key sign
pseudobenediction sign
mutilan deformity
discuss piano key sign
floating of ulnar head due to disruption of ulnar collat ligament
discuss pseudobenediction sign
extensor tendons of 4th and 5th are rupture so stuck in flexion
discuss mutilan deformity
digits are shortened bcs nakain na yung bone s phalanges
most serious arthritic involvement
mutilan deformity
discuss manifestation of RA in hip
not rlly apparent and less commonly involved
LOM and + FABER
discuss manifestation of RA in knee
commonly involved - baker’s cyst
discuss manifestation of RA in foot and ankle
lateral dev of toes - hallux valgus
hammer toe s MTP
give common sites for rheumatoid nodule
olecranon, forearm, achilles and ischial
what is caplan’s syndrome
kaka nodules in lung - rheumatoid pneumoconiosis
discuss manifestation of RA in GI
no specific but gastritis or PUD due to drugs used to treat RA
discuss manifestation of RA in renal
related to drug use din
discuss manifestation of RA in neurologic
myelopathies related to cervical spine
peripheral entrapments - carpal tunnel
discuss manifestation of RA in hematological
anemia and felty’s syndrome
what is felty’s syndrome
splenomegaly, leucopenia and leg ulcer
triad yan
discuss the course and prognosis of RA
intermittent mild disease w partial or complete remission periods
long clinical remissions
progressive and can be rapid or slow but deteriorates regardless
criteria for clinical remission of RA
morning stiffness does not exceed 15 mins
no fatigue
no joint pain
no tenderness or pain on motion
no soft tissue swelling
ESR less than 30/20 mm/hr
30-females
20 males
score needed for clinical remission of RA
5 or more for at least 2 months
criteria for poor prognosis in RA
early age of onset
high RF
presence of rheumatoid nodules
persistent disease for more than 1 yr
HLA-DR4 prototype
class 1 of classification of functional status in RA
complete ADL
class 2 of classification of functional status in RA
able to do self-care and vocational but limited avocational activities
class 3 of classification of functional status in RA
self care but limited vocational and avocational
class 4 of classification of functional status in RA
limited ADL
how to treat RA
patient education
medical therapy
surgery
rehab
discuss patient education for RA
pamonitor activity and stop when pain/fatigue develops
energy conservation - 3 sessions of exercise instead of 1 long
joint protections - avoid deforming activities; pa open door w 2 hands
discuss surgery for RA
soft tissue: synovectomy, tendon transfer, soft tissue release
bone and joint: osteotomy, arthroplasty/desis
discuss pain modalities for RA
superficial heat
deep heat
cold
TENS
discuss exercise for RA
joint mob - pag di swollen
strengthening
endurance
functional
gait
discuss splinting for RA
ulnar dev splints
siris silver ring - allows flexion but blocks hyperex
treatment for subacute and chronic RA
intensity of pain, joint swelling, morning stiffness and systemic symptoms diminish
joint protect and activity mod
flexibility and strength
cardiopulmo endurance
OA is aka known as ____
degenerative joint disease - DJD
most common sites of OA
hips, knees, DIP, cervical and lumbar
discuss primary type of OA
due to repetitive mechanical stress and certain anatomy
discuss secondary type of OA
due to previous affectation like sepsis, trauma or inflammation of the joint
most common effect of OA
pain
most disabling MSK disorder
OA
most common rheumatic disease
OA
describe OA
chronic disabling disease and is vv common
affects articular cartilage
occurrence of OA
women 45 and above
male 45 below
common race for knee OA
black
common race for hip OA
european whites
relate women to OA
more serious disabling symptoms - morning stiff, swelling and night pain
higher chance for heberden’s nodes
risk factors of OA
age and work - primarily
obesity - 2nd
MSK injury
overuse
pathologic features of OA
progressive destruction of articular cartilage tas bone forms at margin of joint
exposure of synovial nociceptor causing pain
compare remodeling of cartilage in normal and OA
normal - balance in catabolic and anabolic
OA - inc in catabolic = loss of collagen and proteoglycans
discuss pathophysio of cartilage destruction
breakdown in central areas muna - small tears or fibrillation
until large tears or clefts na that exposes the bone
discuss pathophysio of subchondral bone
undergoes remodeling in response to load - osteophytes form
discuss pathophysio of synovial membrane and fluid
defective viscosity, elasticity and shielding bcs of inflammatory reaction
criteria for OA diagnosis of knee
clinical and labs is positive
knee pain
age over 50
stiffness less than 30 min
bony tenderness
bony enlargement
no palpable warmth
ESR < 40 mm/hr
Rf < 1:40
non-inflammatory synovial fluid labs
score for OA diagnosis
at least 5/9
radiographic exam grade 0
normal radiograph
radiographic exam grade 1
doubtful narrowing and possible osteophytes
radiographic exam grade 2
definite osteophyte and absent or doubtful narrowing
radiographic exam grade 3
moderate osteophytes and joint space narrowing
some sclerosis and possible deformity
radiographic exam grade 4
large ostephytes and marked narrowing
severe sclerosis and definite deformity
explain how blood workups can be use to diagnose OA
CRP and ESR are normal in OA; so marrule out RA kase mag ppositive pag inflammatory
explain how MRI can be use to diagnose OA
more sensitive than xray - ordered in spinal OA to identify if may entrapment
rule out avascular necrosis
earliest symptom of OA
pain
SSx of OA
localized joint pain worse in activity and relieved w rest
locking or giving away of joint
morning gel less than 30 mins
PE of OA
nodes
crepitus
cool effusions
decrease ROM
tenderness and pain on passive motion
common on WB joints - knee and hips
second common on DIP and PIP of hands
compare heberdens and bouchards nodes
heberden - DIP; HD
bouchard - PIP; BP
deformities due to OA
heberdens and bouchards
swan neck ant buttoniere
ulnar dev, hallux valgus
non-pharmacologic management for OA
weight loss
exercise flexibility
strengthening
inc proprioception and balance
modalities
orthotic managemet
discuss significance of weight loss for OA
obesity is a risk factor - prevent onset and progression if lighter
discuss significance of flexibility for OA
decreases shortening of tendinous structures
dec joint stiffness
dec shortening of muscles
avoid ballistic stretch
discuss significance of strengthening for OA
quads if weak - highly disabling
okc muna until ckc
isometric if may pain until isotonic
most beneficial exercise for OA
isotonic - combi of okc and ckc
discuss significance of proprioception and balance for OA
postural stability reduces impact on hips and knees = decrease progression
discuss significance of hydrotherapy for OA
for improving flexibillity
discuss significance of ice for OA
good for ROM, function and knee strength tas dec swelling
discuss significance of TENS for OA
relieves pain and improves function
discuss significance of orthotic management for OA
reduces ambulation induced pain = better function
helps in energy conservation and joint protection = delay onset or progrression
pharmacologic management of OA
acetaminophen, NSAIDS, steroids or COx2
surgical intervention for OA
THR
compare RA and OA in terms of cause
RA: autoimmune
OA: degenerative
compare RA and OA in terms of affected area
RA - synovium
OA - cartilage
compare RA and OA in terms of risk factors
RA - women and family history
OA - women over 45 and men less than 45, obesity, overuse, anatomic dispositions
compare RA and OA in terms of joints affected
RA - small joints of hand and feet; MCP, wrist and PIP tas symmetrical
OA - WB joints like knee, DIP and PIP tas 1st CMC and assymetrical
compare RA and OA in terms of symptoms
RA - swelling
OA - non-inflammatory sa late stages lng
compare RA and OA in terms of onset
OA - old age and slow; degenerative
RA - any time; rapid mga weeks to months lng
compare RA and OA in terms of joint symptoms
OA - pain w no swelling
RA - pain w swollen and stiff
compare RA and OA in terms of morning stiffness
OA - less than 1 hr
RA - more than 1 hr
compare RA and OA in terms of systemic symptoms
OA - wala
RA - fatigue and ill like symptoms
compare RA and OA in terms of associated symptoms
OA - in isolation and no systemic
RA - fevers, weight loss etc
compare RA and OA in terms of severity
OA - less
RA - more
compare RA and OA in terms of disease process
OA - wear and tear
RA - autoimmune
compare RA and OA in terms of diagnosis
OA - xray
RA - blood tests
compare RA and OA in terms of pharmacol
OA - NSAID
RA - NSAID, steroids, immunosuppresants
compare RA and OA in terms of pattern of joints affected
OA - affect one side and may spread to other side gradually and limited to one set of joints - WB joints, DIP, 1st CMC
RA - small and large joints symmetrically - hands, wrists, elbow, feet
