Osteoarthritis Flashcards by tcarlso 3

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

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What are the two general forms of OA?

Primary = idiopathic

- Secondary = 2/2 other dz

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What is the most common cause of secondary OA in the US?

Obesity

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What, generally, is OA?

Degeneration of cartilage and its underlying bone within a joint, as well as bony overgrowth

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What are the radiographic findings of OA? (3)

Joint space narrowing
Subchondral sclerosis
Osteophyte formation

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Which extremity joint is not affected with OA?

Elbow

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Is RA symmetric or asymmetric involvement? Single or multiple?

Symmetric, polyarthritis

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What are bouchard’s nodes?

DIP nodes in OA

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What are the palpable characteristic difference of nodes in RA vs OA?

OA = hard
RA = squishy

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What are the non-pharmacological treatments for OA? (4)

Weight loss / exercise
Joint protection
Assistive devices
PT/OT

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Is exercise good for OA joints?

Moderate exercise, Yes

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What is the major guide for treatment of OA?

How much it affects pt’s life

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What are the meds that change the disease course of OA?

None

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What are the meds that are used to treat OA?

NSAIDs
Glucocorticoids
Tramadol

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Which is better for pain with OA: acetaminophen or an NSAID?

NSAID

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What is the antidepressant that can improve OA pain?

Duloxetine

hyaluronates

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What are the recommended intra articular therapies for OA?

Glucocorticoids

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What is the only NSAID that is available in topical form?

Diclofenac

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True or false: NSAIDs are generally safe to use in OA

False, due to side effects of chronic use

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What is the MOA of celecoxib?

Specific COX-2 inhibitor

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True or false: there is no platelet effects with celecoxib

True

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What is the major side effect of celecoxib?

Potential increase in Cardiovascular events

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What are the 3 overall goals of treating OA?

Pain control
Improve QOL / function
Avoid toxicity

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When is the age of onset for RA?

30-50 years

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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?