OA, RA

Question 1

Most common form of arthritis is

Answer 1

OA

Question 2

leading cause of disability in ages over 65

Answer 2

OA

Question 3

OA a/w

Answer 3

age, obesity, previous trauma, and abnormal joint mechanics

Question 4

how is ROM affected in OA

Answer 4

decreased

Question 5

types of nodes in OA

Answer 5

heberden’s- DIP, bouchards- PIP

Question 6

labs ordered in OA

Answer 6

CBC with diff, CMP, ESR, CRP, ANA/RA

Question 7

XRAY finding in OA

Answer 7

joint narrowing d/t loss of articular cartilage, subchondral bone thickening and hardening, sclerosis, subchondral cysts, osteophytes

Question 8

joint aspiration in OA vs. RA

Answer 8

OA is non-inflammatory so cell count less than 500, mostly mononuclear. RA is inflammatory- cell count more than 2,000, predominantly NEUTROPHILS

Question 9

calcium pyrophosphate dihydrate crystals seen in joint aspiration- suspect…

Answer 9

pseudogout

Question 10

If bone pain at night, think-

Answer 10

metastatic bone cancer

Question 11

ddx of OA that is characterized by fracture, subluxation, and/or dislocation of a joint that goes unnoticed d/t neurologic damage

Answer 11

charcot’s joint

Question 12

charcot’s joint most commonly affected joint-

Answer 12

ankle- highly stressed

Question 13

tx of OA focused on..

Answer 13

weight loss (reduces pressure of joints), regular exercise (low impact- water aerobics, yoga), and treating joints with respect- avoid repetitive or improper use. keep stretching!

Question 14

injections FDA approved for knee and shoulder in OA

Answer 14

viscosupplement. steroids can also be used for larger joints

Question 15

surgery types in OA

Answer 15

arthroscopy, osteotomy, partial/total

Question 16

nsaid contraindication and SE

Answer 16

contraindicated in pregnancy. SE- GI bleed, kidney disease, CAD

Question 17

4 risk factors a/w RA

Answer 17

HLA-DR4 and HLS-DR4 surface antigen, family history, native american ethnicity, female 20-50

Question 18

target population for testing RA

Answer 18

1 or more joints with definite clinical synovitis, synovitis cannot be explained by other diseases (r/o overuse, virus, lyme disease)

Question 19

classification criteria for RA

Answer 19

6 or more points out of 10- can include joint involvement (more joints involved- more points), serology (RF), abnormal ESR or CRP, and duration of symptoms (6 or more weeks is a point)

Question 20

atypical RA

Answer 20

palindomic rheumatism, presting with systemic symptoms or generalized fatigue first then joint pain follows

Question 21

characteristics of palindromic rheumatism

Answer 21

episodic RA, 1- several joint areas affected, symptoms last for hours to days, can involve symptom free episodes, often progresses to CLASSIC RA

Question 22

describe CLASSIC RA

Answer 22

AM stiffness more than 1 hour, symmetrical joint pain, stiffness, swelling esp of PIP, MCP, MTP, wrist. can be a/w polymyalgia rheumatica

Question 23

RA polyarthroapy or monoarthropathy?

Answer 23

POLY

Question 24

predominate sign in RA

Answer 24

synovial thicking- boggy joint (wet, not firm) and heat generally present, redness rarely

Question 25

worst case of RA=

Answer 25

felty’s syndrome

Question 26

what is triad of felty’s?

Answer 26

neutropenia, splenomegaly, deforming RA

Question 27

Xray in RA

Answer 27

loss of joint space (joint narrowing), periarticular thinning, ulnar deviation, MCP swelling joint destruction and disassociation

Question 28

four characteristics of RA

Answer 28

inflammatory, polyarticular, periarticular, and symmetric

Question 29

RA vs. fifth’s disease

Answer 29

fifths disease is common in children and is self limited. RA- will not go away

Question 30

RA vs. polymyalgia rheumatica

Answer 30

blood test. tenderness on palpation of temporal a.

Question 31

RA vs. rheumatic fever

Answer 31

strep test, ASL

Question 32

Tx in RA focuses on:

Answer 32

treating pain, and preventing deformity and disability

Question 33

OT and PT tx options for RA

Answer 33

joint protection and adaptive quipment, ultrasound, low level laser therapy (helps with AM stiffness)

Question 34

meds for RA

Answer 34

NSAIDS- for pain, corticosteroids, synthetic or biologic DMARDS, combinations

Question 35

synthetic DMARDS- first and second line

Answer 35

first line- methotrexate oral or sc. 2nd line- sulfasalazine

Question 36

Biologic DMARDS site of action

Answer 36

TNF inhibitors- Adalimumab, influximab. Non- TNF DMARDS- Abatacept (blocks t cell stimulation), Rituximab (anti CD20), tocilizumab- blocks IL-6

Question 37

describe hand deformities in RA

Answer 37

ulnar deviation, boutonniere deformity (flexion of PIP, hyperextension of DIP), and swan-neck deformity (extension of PIP, flexion of DIP)

Question 38

associated condiitons with RA

Answer 38

felty’s and sjogrens

Question 39

felty’s syndrome initital and later descriptions

Answer 39

initially- neutropenia, splenomegaly, leg ulcers, RA positive. Later- lymphadenopathy, thrombocytopenia, HLA-DR4