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academic weapon > MS1: RA and OA > Flashcards

MS1: RA and OA Flashcards

1
Q

what is RA ?

A

a chronic, inflammatory, autoimmune disease that affects the synovium

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2
Q

occurrence of RA

A

50 yo female

more in women
peak in 4th and 6th decade - 50 yo
increase chance w age

americans - caucasians - black - asian

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3
Q

describe onset of RA

A

insidous

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4
Q

most common joints affected by RA

A

wrist, MCP, PIP and MTP

as disease progresses it affects larger - mga knees, elnow and ankle

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5
Q

what is spared in RA

A

DIP and thoracolumbar

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6
Q

main characteristics of RA

A

symmetrical joint involvement pf small joints of feet

morning stiffness more than an hour

systemic symptoms

extraarticular manifestations

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7
Q

what are the extraarticular manifestations of RA

A

rheumatoid nodules

shortness of breath and chest pain - cardiopulmo involvement

orbital redness - scleresis

dry eyes and mouth

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8
Q

hallmark symptom of RA

A

morning stiffness more than an hour

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9
Q

most common extraarticular manifestation of RA

A

rheumatoid nodule

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10
Q

common site for rheumatoid nodules

A

extensor surfaces and areas subjected to mech pressure

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11
Q

occurrence of pleuropulmonary manifestations

A

more in men - pulmonary fibrosis and nodules

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12
Q

when does scleritis commonly occur

A

6th decade and more on women
BILAT

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13
Q

if u have scleritis what does it mean

A

more advanced RA - more extraarticular manifestations

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14
Q

classical criteria for RA

A

morning stiffness

arthritis of 3 or more joints

arthritis of hand

symmetric

rheumatoid nodules

serum rheumatoid factor

radiographic changes

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15
Q

requirements for classical criteria

A

score at least 4/7 and 1-4 must last for at least 6 wks

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16
Q

possible areas for arthritis of 3 or more factor

A

R and L

PIP
MCP
wrist
elbow
knee
ankle
MTP

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17
Q

possible areas for arthritis of hand

A

wrist, MCP or PIP

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18
Q

modern scoring for RA - joint involvement

A

1: one large joint

2: 2-10 large joints

3: 1-3 small joints

4: 4-10 small joints

5: > 10 joints

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19
Q

modern scoring for RA - lab studies

A

0: negative RF + CCP

2: low positive RF + CCP

3: high positive RF + CCP

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20
Q

modern scoring for RA - acute phase reactants

A

0: normal CRP and ESR

1: abnormal CRP and ESR

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21
Q

modern scoring for RA - duration

A

0: less than 6 wks

1: more than 6 wks

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22
Q

diagnosis for modern criteria of RA

A

score 6 or higher

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23
Q

discuss the pathophysiology of RA

A

inflammation in synovium

pannus forms - grainy tissue that erodes cartilage

tendons get inflamed or rupture = joint fusion

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24
Q

discuss manifestation of RA in cervical spine

A

atlantoaxial and midcervical

neck stiff and LOM

C1-C2 instability and compression

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25
Q

discuss manifestation of RA in TMJ

A

limited mouth opening

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26
Q

discuss manifestation of RA in shoulders

A

LOM - frozen shoulder syndrome or adhesive cap

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27
Q

discuss manifestation of RA in elbow

A

flexion deformity
ulnar compression

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28
Q

discuss manifestation of RA in wrists

A

flexion contracture - dec power grasp

radial dev of distal carpals

dequervain’s

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29
Q

discuss manifestation of RA in hand

A

boutonniere of thumb

ulnar dev of MCP

swan neck

piano key sign

pseudobenediction sign

mutilan deformity

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30
Q

discuss piano key sign

A

floating of ulnar head due to disruption of ulnar collat ligament

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31
Q

discuss pseudobenediction sign

A

extensor tendons of 4th and 5th are rupture so stuck in flexion

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32
Q

discuss mutilan deformity

A

digits are shortened bcs nakain na yung bone s phalanges

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33
Q

most serious arthritic involvement

A

mutilan deformity

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34
Q

discuss manifestation of RA in hip

A

not rlly apparent and less commonly involved

LOM and + FABER

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35
Q

discuss manifestation of RA in knee

A

commonly involved - baker’s cyst

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36
Q

discuss manifestation of RA in foot and ankle

A

lateral dev of toes - hallux valgus

hammer toe s MTP

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37
Q

give common sites for rheumatoid nodule

A

olecranon, forearm, achilles and ischial

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38
Q

what is caplan’s syndrome

A

kaka nodules in lung - rheumatoid pneumoconiosis

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39
Q

discuss manifestation of RA in GI

A

no specific but gastritis or PUD due to drugs used to treat RA

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40
Q

discuss manifestation of RA in renal

A

related to drug use din

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41
Q

discuss manifestation of RA in neurologic

A

myelopathies related to cervical spine

peripheral entrapments - carpal tunnel

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42
Q

discuss manifestation of RA in hematological

A

anemia and felty’s syndrome

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43
Q

what is felty’s syndrome

A

splenomegaly, leucopenia and leg ulcer

triad yan

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44
Q

discuss the course and prognosis of RA

A

intermittent mild disease w partial or complete remission periods

long clinical remissions

progressive and can be rapid or slow but deteriorates regardless

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45
Q

criteria for clinical remission of RA

A

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

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46
Q

score needed for clinical remission of RA

A

5 or more for at least 2 months

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47
Q

criteria for poor prognosis in RA

A

early age of onset

high RF

presence of rheumatoid nodules

persistent disease for more than 1 yr

HLA-DR4 prototype

48
Q

class 1 of classification of functional status in RA

A

complete ADL

49
Q

class 2 of classification of functional status in RA

A

able to do self-care and vocational but limited avocational activities

50
Q

class 3 of classification of functional status in RA

A

self care but limited vocational and avocational

51
Q

class 4 of classification of functional status in RA

A

limited ADL

52
Q

how to treat RA

A

patient education
medical therapy
surgery
rehab

53
Q

discuss patient education for RA

A

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

54
Q

discuss surgery for RA

A

soft tissue: synovectomy, tendon transfer, soft tissue release

bone and joint: osteotomy, arthroplasty/desis

55
Q

discuss pain modalities for RA

A

superficial heat
deep heat
cold
TENS

56
Q

discuss exercise for RA

A

joint mob - pag di swollen

strengthening
endurance
functional
gait

57
Q

discuss splinting for RA

A

ulnar dev splints

siris silver ring - allows flexion but blocks hyperex

58
Q

treatment for subacute and chronic RA

A

intensity of pain, joint swelling, morning stiffness and systemic symptoms diminish

joint protect and activity mod
flexibility and strength
cardiopulmo endurance

59
Q

OA is aka known as ____

A

degenerative joint disease - DJD

60
Q

most common sites of OA

A

hips, knees, DIP, cervical and lumbar

61
Q

discuss primary type of OA

A

due to repetitive mechanical stress and certain anatomy

62
Q

discuss secondary type of OA

A

due to previous affectation like sepsis, trauma or inflammation of the joint

63
Q

most common effect of OA

A

pain

64
Q

most disabling MSK disorder

A

OA

65
Q

most common rheumatic disease

A

OA

66
Q

describe OA

A

chronic disabling disease and is vv common

affects articular cartilage

67
Q

occurrence of OA

A

women 45 and above

male 45 below

68
Q

common race for knee OA

A

black

69
Q

common race for hip OA

A

european whites

70
Q

relate women to OA

A

more serious disabling symptoms - morning stiff, swelling and night pain

higher chance for heberden’s nodes

71
Q

risk factors of OA

A

age and work - primarily

obesity - 2nd

MSK injury

overuse

72
Q

pathologic features of OA

A

progressive destruction of articular cartilage tas bone forms at margin of joint

exposure of synovial nociceptor causing pain

73
Q

compare remodeling of cartilage in normal and OA

A

normal - balance in catabolic and anabolic

OA - inc in catabolic = loss of collagen and proteoglycans

74
Q

discuss pathophysio of cartilage destruction

A

breakdown in central areas muna - small tears or fibrillation

until large tears or clefts na that exposes the bone

75
Q

discuss pathophysio of subchondral bone

A

undergoes remodeling in response to load - osteophytes form

76
Q

discuss pathophysio of synovial membrane and fluid

A

defective viscosity, elasticity and shielding bcs of inflammatory reaction

77
Q

criteria for OA diagnosis of knee

A

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

78
Q

score for OA diagnosis

A

at least 5/9

79
Q

radiographic exam grade 0

A

normal radiograph

80
Q

radiographic exam grade 1

A

doubtful narrowing and possible osteophytes

81
Q

radiographic exam grade 2

A

definite osteophyte and absent or doubtful narrowing

82
Q

radiographic exam grade 3

A

moderate osteophytes and joint space narrowing

some sclerosis and possible deformity

83
Q

radiographic exam grade 4

A

large ostephytes and marked narrowing

severe sclerosis and definite deformity

84
Q

explain how blood workups can be use to diagnose OA

A

CRP and ESR are normal in OA; so marrule out RA kase mag ppositive pag inflammatory

85
Q

explain how MRI can be use to diagnose OA

A

more sensitive than xray - ordered in spinal OA to identify if may entrapment

rule out avascular necrosis

86
Q

earliest symptom of OA

A

pain

87
Q

SSx of OA

A

localized joint pain worse in activity and relieved w rest

locking or giving away of joint

morning gel less than 30 mins

88
Q

PE of OA

A

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

89
Q

compare heberdens and bouchards nodes

A

heberden - DIP; HD

bouchard - PIP; BP

90
Q

deformities due to OA

A

heberdens and bouchards

swan neck ant buttoniere

ulnar dev, hallux valgus

91
Q

non-pharmacologic management for OA

A

weight loss
exercise flexibility
strengthening
inc proprioception and balance
modalities
orthotic managemet

92
Q

discuss significance of weight loss for OA

A

obesity is a risk factor - prevent onset and progression if lighter

93
Q

discuss significance of flexibility for OA

A

decreases shortening of tendinous structures

dec joint stiffness

dec shortening of muscles

avoid ballistic stretch

94
Q

discuss significance of strengthening for OA

A

quads if weak - highly disabling

okc muna until ckc

isometric if may pain until isotonic

95
Q

most beneficial exercise for OA

A

isotonic - combi of okc and ckc

96
Q

discuss significance of proprioception and balance for OA

A

postural stability reduces impact on hips and knees = decrease progression

97
Q

discuss significance of hydrotherapy for OA

A

for improving flexibillity

98
Q

discuss significance of ice for OA

A

good for ROM, function and knee strength tas dec swelling

99
Q

discuss significance of TENS for OA

A

relieves pain and improves function

100
Q

discuss significance of orthotic management for OA

A

reduces ambulation induced pain = better function

helps in energy conservation and joint protection = delay onset or progrression

101
Q

pharmacologic management of OA

A

acetaminophen, NSAIDS, steroids or COx2

102
Q

surgical intervention for OA

A

THR

103
Q

compare RA and OA in terms of cause

A

RA: autoimmune

OA: degenerative

104
Q

compare RA and OA in terms of affected area

A

RA - synovium

OA - cartilage

105
Q

compare RA and OA in terms of risk factors

A

RA - women and family history

OA - women over 45 and men less than 45, obesity, overuse, anatomic dispositions

106
Q

compare RA and OA in terms of joints affected

A

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

107
Q

compare RA and OA in terms of symptoms

A

RA - swelling

OA - non-inflammatory sa late stages lng

108
Q

compare RA and OA in terms of onset

A

OA - old age and slow; degenerative

RA - any time; rapid mga weeks to months lng

109
Q

compare RA and OA in terms of joint symptoms

A

OA - pain w no swelling

RA - pain w swollen and stiff

110
Q

compare RA and OA in terms of morning stiffness

A

OA - less than 1 hr

RA - more than 1 hr

111
Q

compare RA and OA in terms of systemic symptoms

A

OA - wala

RA - fatigue and ill like symptoms

112
Q

compare RA and OA in terms of associated symptoms

A

OA - in isolation and no systemic

RA - fevers, weight loss etc

113
Q

compare RA and OA in terms of severity

A

OA - less

RA - more

114
Q

compare RA and OA in terms of disease process

A

OA - wear and tear

RA - autoimmune

115
Q

compare RA and OA in terms of diagnosis

A

OA - xray

RA - blood tests

116
Q

compare RA and OA in terms of pharmacol

A

OA - NSAID

RA - NSAID, steroids, immunosuppresants

117
Q

compare RA and OA in terms of pattern of joints affected

A

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

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