Osteoarthritis Flashcards
What is the major difference between osteoarthritis and RA, in terms of abnormal bone findings?
OA is degenerative, and bone spurs form
RA causes erosion of the bones
What are the two general forms of OA?
- Primary = idiopathic
- Secondary = 2/2 other dz
What is the most common cause of secondary OA in the US?
Obesity
What, generally, is OA?
Degeneration of cartilage and its underlying bone within a joint, as well as bony overgrowth
What are the radiographic findings of OA? (3)
- Joint space narrowing
- Subchondral sclerosis
- Osteophyte formation
Which extremity joint is not affected with OA?
Elbow
Is RA symmetric or asymmetric involvement? Single or multiple?
Symmetric, polyarthritis
What are bouchard’s nodes?
DIP nodes in OA
What are the palpable characteristic difference of nodes in RA vs OA?
OA = hard RA = squishy
What are the non-pharmacological treatments for OA? (4)
- Weight loss / exercise
- Joint protection
- Assistive devices
- PT/OT
Is exercise good for OA joints?
Moderate exercise, Yes
What is the major guide for treatment of OA?
How much it affects pt’s life
What are the meds that change the disease course of OA?
None
What are the meds that are used to treat OA?
- NSAIDs
- Glucocorticoids
- Tramadol
Which is better for pain with OA: acetaminophen or an NSAID?
NSAID
What is the antidepressant that can improve OA pain?
Duloxetine
hyaluronates
What are the recommended intra articular therapies for OA?
Glucocorticoids
What is the only NSAID that is available in topical form?
Diclofenac
True or false: NSAIDs are generally safe to use in OA
False, due to side effects of chronic use
What is the MOA of celecoxib?
Specific COX-2 inhibitor
True or false: there is no platelet effects with celecoxib
True
What is the major side effect of celecoxib?
Potential increase in Cardiovascular events
What are the 3 overall goals of treating OA?
- Pain control
- Improve QOL / function
- Avoid toxicity
When is the age of onset for RA?
30-50 years
True or false: RA has increased risk of mortality. Why or why not?
True–Chronic inflammation increases chances of CV disease
What is the role of RA drugs in the mortality rate associated with RA?
Increases life span
What are the criteria for RA?
- Morning stiffness
- Arthritis of 3+ joints
- Arthritis of hand joints
- Symmetric arthritis
- Rheumatoid nodules
- Serum Rh factor
- Radiographic changes
In order to diagnose RA, how many joints needed to affected?
3+ or the hands
How long does the morning stiffness need to last to meet criteria for RA?
hour or more
How does the morning stiffness compare between OA and RA?
RA = lasts hours OA = resolves within an hour
What is Rh factor?
IgM bound to the Fc portion of IgG
What is the antibody that is fairly specific to RA?
Anti-CCP (cyclic citrullinated peptide)
What is the pathophysiology of RA?
Pannus forms within a joint, causing joint destruction and synovitis
What are the radiological findings of RA?
Joint space narrowing and bone erosion
How are the radiological findings between OA and RA different?
RA is symmetric joint narrowing, without bone spurs
OA, the medial portion of the joint degraded first. Bone spurs are present
Where are rheumatoid nodules usually found?
Extensor surfaces, usually on the forearm or hand
What are the ocular issues that arise from RA?
- Dry eyes, leading to ulceration
- Scleritis
What type of hypersensitivity reaction is RA?
III and IV
What are the popliteal findings of RA?
Bakers cysts
What is the HLA haplotype that is associated with RA?
HLA-DR4
What are the two HLA haplotypes associated with celiac disease?
HLA-DR2 and HLA-DR8
Which improves with use, and which improves with rest: OA vs RA?
RA improves with use
OA improves with rest
What is caplan’s syndrome?
a combination of RA and pneumoconiosis that manifests as intrapulmonary nodules, which appear homogenous and well-defined on chest X-ray
Why is it important to refer RA early?
Stop the morbidity associated with joint destruction
What is the role of corticosteroids in treating RA?
Bridge therapy for the onset of action of second line agents
What is the role of NSAIDs in RA?
Might help with pain, but not disease modifying, and has multiple side effects
What is the drug of choice for RA? Is it used in monotherapy?
Methotrexate
Can be used in monotherapy or combination
What are the side effects of methotrexate?
- Hepatic fibrosis
- Myelosuppression
- Pulmonary toxicity
What is the MOA of methotrexate?
competitively inhibits dihydrofolate reductase (DHFR), an enzyme that participates in the tetrahydrofolate synthesis
What, generally, is the Sharp’s score?
Scoring method for determining the severity of RA, based on joint space narrowing in hands and feet
What is the role of DMARDs in treating RA?
- may slow down or prevent joint damage
- Frequently used in combination
What is the MOA, use, and side effects of Rituximab?
- Monoclonal antibody against CD20, to target B cells
- NHL, RA
- Increases risk of progressive encephalopathy
What is the MOA and use of Vemurafenib?
- Small molecule inhibitor of forms of the B-RAf kinase with the V600E mutation
- Metastatic melanoma
What is the MOA, use, and side effects of Bevacizumab?
- Ab against VEGF to inhibit angiogenesis
- Solid tumors
- Hemorrhage and impaired wound healing
What is the MOA, use, and side effects of Imatinib?
- Tyrosine kinase inhibitor of bcl-abl of the Philadelphia chr fusion gene in CML
- Fluid retention
What is the MOA, use, and side effects of Trastuzumab?
- Ab against HER-2
- HER2+ breast cancer
- Cardiotoxic (“heart-ceptin damages the heart”)
(“tras-2-zumab”)
What is the MOA, use, and side effects of Tamoxifen?
- SERM
- ER+ breast cancer
- Increases risk of endometrial cancer
What is the MOA of etanercept?
Receptor for TNF-alpha
What are the side effects of anti-TNF-alpha drugs?
- Expensive
- Increased risk of infections
- malignancy
What are the two major infectious complications from TNF alpha inhibitor use?
Granulomatous diseases like TB and histo
What are the cytokine that are responsible for initiating the formation, and maintenance of granulomas?
Th1 cells secrete gamma IFN to activate macrophages to form granuloma
TNF-alpha from macrophages induce and maintain granuloma formation
What must always be tested for prior to starting anti-TNF-alpha drugs?
TB
