OA + RA

Question 1

what is autoimmunity

Answer 1

adaptive immune response against self tissues and cells

Question 2

what is OA

Answer 2

articular fibrocartilage thinning/ loss from wear and tear

Question 3

what is the pathogenesis of OA

Answer 3

decrease in ECM synthesis

Question 4

what factors can influence OA development

Answer 4

ageing, obesity, occupation/ hobbies/ sports (weight loading), muscle weakness

Question 5

what can cause secondary OA

Answer 5

gout, spondylopathies, Paget’s, AVN, metabolic and systemic disease

Question 6

what joints are commonly affected

Answer 6

hands DIP, PIP, knee, hip, spine (cervical and lumbar)

Question 7

what clinical features are there of OA

Answer 7

crepitus, osteophytes, effusion/ baker’s cyst (knee), osteophytes –> spinal stenosis (numb/ pain)

Question 8

what is seen on X ray on an osteoarthritic joint

Answer 8

Loss of joint space, osteophytes, subchondral cyst (fluid herniating out), subchondral sclerosis

Question 9

what symptoms of OA are there (stiffness and pain)

Answer 9

worse on exertion, relieved by rest, stiffness that lasts less than 30mins, pain in joint and loss of function

Question 10

what are lifestyle managements of OA

Answer 10

physio, weight loss, exercise, walking aids

Question 11

what drugs can be used in OA (mild –> severe)

Answer 11

analgesia (paracetamol/ topical), NSAIDs, pain modulators, intra-articular steroid injections, surgical joint replacement

Question 12

what pain modulators can be used on OA

Answer 12

tricyclics eg amitriptyline, anticonvulsants eg gabapentin (nerve pain)

Question 13

what nodes can be seen at DIP and PIP joints

Answer 13

Herberden’s and Bouchard’s

Question 14

what is rheumatoid arthritis

Answer 14

an inflammatory, autoimmune, seropositive disease affecting joints and is also systemic

Question 15

who is most likely to get RA

Answer 15

females 30-50 (pre menopause), smokers

Question 16

what gene can be present in RA

Answer 16

HLA DRB1

Question 17

what can be seen in early stages of RA

Answer 17

pannus formation - inflamed synovium

Question 18

what can be seen in chronic fibrosis

Answer 18

fibrosis, bony erosions and osteophytes

Question 19

what are the joint symptoms present in RA

Answer 19

pain and stiffness lasting >30 mins, usually symmetrical relieved by exercise. swollen joints (sore when squeezed), general MSK pain

Question 20

what joints are commonly affected in RA

Answer 20

PIP, MCP, MTP (DIP spared)

Question 21

what systemic symptoms of RA can present

Answer 21

SUBCUT NODES, OSTEOPOROSIS, lungs (fibrosis, Plural effusions), uveitis + scleritis, alopecia, CVD, renal

Question 22

what is the DAS28 score

Answer 22

shows how severe disease is, 5.1+ = active disease

Question 23

what bloods and autoantibodies can be done for RA

Answer 23

CRP, ESR, low Hb
anti-CCP
(RF - not very specific)

Question 24

what imaging can be done for RA

Answer 24

USS can catch synovitis in early disease. MRI if severe

Question 25

what drug therapy can be used for RA

Answer 25

DMARDs (methotrexate), NSAIDs, steroids, biologics (infliximab)

Question 26

when would biologics be started in RA

Answer 26

tried 2 DMARDs and high DAS 28