Musculoskeletal Arthritis (Exam 4) Flashcards
Arthritis Types
Osteoarthritis
Rheumatoid Arthritis
Arthritis Affects what joints the most
Synovial Joints
Synovial Joints
A movable joint composed of an outer fibrous capsule, interior synovial membranes, articular cartilage, and synovial fluid
The bones come together and move easily because of the smooth surfaces of articular cartilage and lubrication of synovial fluid
Arthropathy
A joint disorder that involves INFLAMMATION of one or more joint –> arthritis
(arthropathy leads to arthritis)
Osteoarthritis
Degeneration of joints caused by aging and stress
Most common cause of disability in the US
What is causing incidence of OA to increase?
Obesity and longer life expectancy
Common Joints Affected by OA
Cervical and Lumbosacral spine
Hip
Knee
Hands
First metatarsal phalangeal joint (big toe)
Joints that are spared by by OA
Wrist
Elbows
Ankles
OA risk factors
Aging (loose cartilage over 40)
Obesity (Increase Strain)
History of participation in team sports
History of trauma or overuse
Heavy occupational work (outside and etc)
Misalignment of pelvis, hip, knee, ankle or foot.
OA: Etiology
Stresses applied to joint (Weight bearing)
Degeneration of cartilage
-Excessive loading of healthy joint
-Normal loading of previously injured joint
Chronic Disease
OA Pathophysiology
Pressure on joint wear away carliage. This leads to CYST development. Cyst move through cartilage and destroy the rest.
Localized inflammation lead to more degradation
Chondrocytes Synthesize fluid called proteoglycans –> causes more swelling
Osteoblasts activation leads to bone spurs and synovial fluid thickening
Loss of cartilage narrows the joint space
What causes bone spurs in OA
Osteoblast activation trying to fix the problem
Clinical Manifestations of OA
Deep aching joint pain, especially within exertion (Relieved with rest)
Joint pain with cold weather
Stiffness in the morning (feels better once moving)
Crepitus of joint during motion
Join swelling
Altered gait
Limited range of motion
What is an important hallmark of OA
Osteophytes which are bone spurs made by osteoblast
OA: Physical Exam Findings
-Joint deformity
-Joint tenderness
-Decreased range of motion
Fingers often involved:
-Heberden’s Nodes - distal interphalangeal joint
-Bouchard’s nodes - proximal interphalangeal joint
Heberden’s nodes
Distal interphalangeal joint
Bouchard’s nodes
Proximal interphalangeal joint
Treatment for OA: Goals
Manage Pain
Maintain mobility
Minimize disability
OA pain treatment for Mild pain
Start with acetaminophen and move to NSAIDS (OTC). Topical Capsaicin (hot chilly pepper)
OA pain treatment for Severe Pain
NSAIDS (rx strengthI, NSAIDs + colchicine, acetaminophen + tramadol, opioids, steroid injection)
REVIEW ALL OF NSAIDS
Contraindicated for patients with PUD
Use with caution in those with history of GI bleeds
GI RISK BLEED
NEPHROTOXIC
USE LOWEST EFFECTIVE DOSE POSSIBLE
Degenerative Disc Disease (DDD)
Is common cause of pain, motor weakness, and neuropathy
Most often occurs in lumbar or cervical spine
(L4-S1)
Degenerative Discs
Intervertebral disc compression occurs with age
Motor and sensory spinal nerves enter and exit from the spinal cord and travel through narrow openings of the vertebral bone
With age intervertebral discs dehydrate and vertebral bone become compresse –> impinge on the entering and exiting nerves
Dysfunction of motor and sensory spinal nerves impeded movement and sensation in the extremities
May see weakness and paresthesias
Signs and Symptoms of DDD: Lumbar
Pain in the lower back that radiates down the back of the leg (sciatica)
Pain in the buttocks or thighs
Pain worsens when sitting, bending, lifting, or twisting
Pain that minimized when walking, changing positions, or lying down
Numbness, tingling or weakness in the legs
Foot drop
Signs and Symptoms of DDD: Cervical
Chronic neck pain that can radiate to the shoulders and down the arms
Numbness or tingling in the arm or hand
Weakness of the arm or hand
RA: Definition
Systemic autoimmune disease
Type III hypersensitivity
(Body attack synovial tissues in the joint. Immune complexes are deposited which further helps inflammatory process and destroys area of joint)
RA Pathogenesis
Immune cells (lymphocytes and macrophages) attack synovial tissue
Produces RF (Rheumatoid Factors):
Antibody against the body’s own antibodies (IgG)
Formation of immune complex
Pannus develops = Scar tissue in the joints:
Inflammation and exuberant proliferation of synovium (hypertrophied synovium)
Immune cells
RF
Osteoclast
Pannus
How do we confirm diagnosis of RA
Measuring RF in the serum
What is Pannus?
Scar tissue and inflammation of synovial joint
Pannus in RA leads to
Bone Erosion
Bone Cysts
Fissure development
RA: Etiology
-Not well understood
-Environmental and genetic factors (Genetic link plus triggering event)
RA: RF’s
-Age 40’s and 60’s
-Women 2x greater risk
-Tobacco us
-Family history (Genetics) (Significant)
Clinical Manifestations of RA: Early - Eventual - Advanced Disease
Early: Very little, maybe joint pain/discomfort
Eventual Joint Manifestations:
-Symmetrical
-Pain, stiffness, motion limitation inflammation: heat, swelling tenderness
Advanced Disease: Deformity and disability
Joint subluxation
OA vs RA: Joints and Swelling
OA = wear and tear one a particular joint
RA= Symmetrical
OA swelling = hard
RA swelling = soft and spongy
RA has more
Systemic Involvement
Other body systems than just joint
-Fatigue and malaise
-Potentially affects ant and all body systems
Common unqiue symptoms for RA
Sjogren syndrome
Rheumatoid Nodules
Sjogren Syndrome
Destruction of moisture-producing gland (salivary and lacrimal)
Rheumatoid Nodules
Immune mediated granulomas; develop around inflamed joints, subcutaneous and firm, sometimes painful
Goals of Pharm for RA
Relieve pain and swelling
Slow or stop progression of disease
Long term drug therapy requires patient adherence:
NSAIDS
Glucocorticoids
DMARDs
RA Systemic Involvement
Fatigue and Malasia
Sjorgren Syndrome
Rheumatoid Nodules
