OA + RA Flashcards
what is autoimmunity
adaptive immune response against self tissues and cells
what is OA
articular fibrocartilage thinning/ loss from wear and tear
what is the pathogenesis of OA
decrease in ECM synthesis
what factors can influence OA development
ageing, obesity, occupation/ hobbies/ sports (weight loading), muscle weakness
what can cause secondary OA
gout, spondylopathies, Paget’s, AVN, metabolic and systemic disease
what joints are commonly affected
hands DIP, PIP, knee, hip, spine (cervical and lumbar)
what clinical features are there of OA
crepitus, osteophytes, effusion/ baker’s cyst (knee), osteophytes –> spinal stenosis (numb/ pain)
what is seen on X ray on an osteoarthritic joint
Loss of joint space, osteophytes, subchondral cyst (fluid herniating out), subchondral sclerosis
what symptoms of OA are there (stiffness and pain)
worse on exertion, relieved by rest, stiffness that lasts less than 30mins, pain in joint and loss of function
what are lifestyle managements of OA
physio, weight loss, exercise, walking aids
what drugs can be used in OA (mild –> severe)
analgesia (paracetamol/ topical), NSAIDs, pain modulators, intra-articular steroid injections, surgical joint replacement
what pain modulators can be used on OA
tricyclics eg amitriptyline, anticonvulsants eg gabapentin (nerve pain)
what nodes can be seen at DIP and PIP joints
Herberden’s and Bouchard’s
what is rheumatoid arthritis
an inflammatory, autoimmune, seropositive disease affecting joints and is also systemic
who is most likely to get RA
females 30-50 (pre menopause), smokers
what gene can be present in RA
HLA DRB1
what can be seen in early stages of RA
pannus formation - inflamed synovium
what can be seen in chronic fibrosis
fibrosis, bony erosions and osteophytes
what are the joint symptoms present in RA
pain and stiffness lasting >30 mins, usually symmetrical relieved by exercise. swollen joints (sore when squeezed), general MSK pain
what joints are commonly affected in RA
PIP, MCP, MTP (DIP spared)
what systemic symptoms of RA can present
SUBCUT NODES, OSTEOPOROSIS, lungs (fibrosis, Plural effusions), uveitis + scleritis, alopecia, CVD, renal
what is the DAS28 score
shows how severe disease is, 5.1+ = active disease
what bloods and autoantibodies can be done for RA
CRP, ESR, low Hb
anti-CCP
(RF - not very specific)
what imaging can be done for RA
USS can catch synovitis in early disease. MRI if severe
what drug therapy can be used for RA
DMARDs (methotrexate), NSAIDs, steroids, biologics (infliximab)
when would biologics be started in RA
tried 2 DMARDs and high DAS 28
