Osteoarthritis and Chronic Inflammatory Arthritis

Question 1

Osteoarthritis

Answer 1

Also known as degenerative arthritis - characterized by degeneration of articular cartilage

Question 2

What is the most common type of osteoarthritis?

Answer 2

Primary

Question 3

What are the causes of secondary osteoarthritis?

Answer 3

• Trauma
• Inflammatory Arthritis
• Hereditary Conditions
• Kashin-Bek Disease: Joint hypermobility
• Bone and Endocrine Disorders

Question 4

What is the main population for osteoarthritis?

Answer 4

Elderly - more than 65 yrs

Question 5

What are the risk factors of osteoarthritis?

Answer 5

• Age
• Obesity
• Repetitive Impact
• Genetics

Question 6

What are the clinical characteristics of osteoarthritis?

Answer 6

 Localized joint pain
 Stiffness
 Worse with weight bearing
 Better with rest
 Very little morning stiffness

Question 7

What happens to the joints of the hand with osteoarthritis?

Answer 7

Distal & Proximal interphalangeal joints

- Heberdens & Bouchards nodes

Question 8

What are some large joints affected by osteoarthritis?

Answer 8

• Knees
• Hips
• Cervical Spine

Question 9

What will the x-ray of osteoarthritis show?

Answer 9

• Decreased joint space
• Osteophytes
• Subchondral Sclerosis

Question 10

What is the treatment for osteoarthritis?

Answer 10

• Weight loss/Physical therapy
• NSAIDs
• Joint Replacement

Question 11

Rheumatoid Arthritis

Answer 11

 Systemic
 Chronic
 Inflammatory
 Autoimmune

Question 12

What can rheumatoid arthritis also affect?

Answer 12

Primarily involves joints but can affect extra-articular organs - lungs, blood, eyes, skin, heart, etc.

Question 13

What gender is rheumatoid arthritis more common in?

Answer 13

Women

Question 14

What gene is associated with rheumatoid arthritis?

Answer 14

HLA-DRB1

Question 15

Does OA have swelling?

Answer 15

No

Question 16

Which type of arthritis has morning stiffness?

Answer 16

RA

Question 17

What type of arthritis involves the lumbar spine?

Answer 17

OA

Question 18

What is the pathogenesis of rheumatoid arthritis?

Answer 18

Activation of CD4+ helper T cells that leads to the generation of a pro-inflammatory milieu with destructive enzymes and increased osteoclast activation that can cause bone erosions.

Question 19

Pannus

Answer 19

Pannus is an abnormal layer of fibrovascular tissue or granulation tissue. In RA it can be vascular, dense and layered.

Question 20

What are some lab indications of RA?

Answer 20

• Anti-CCP antibody

- Elevated inflammatory markers

Question 21

Rheumatoid Nodule

Answer 21

Area of fibrinoid necrosis (center) surrounded by palisading histiocytes

Question 22

What is the treatment for rheumatoid arthritis?

Answer 22

• NSAIDs
• Corticosteroids
• DMARDS

Question 23

Anakinra MOA

Answer 23

Anti-IL1

Question 24

Etanercept, Adalimumab, Infliximab MOA

Answer 24

Anti-TNF alpha

Question 25

Tocilizumab MOA

Answer 25

Anti-IL 6

Question 26

Abatacept MOA

Answer 26

CTLA4 agonist | - Blocks CD28 co-stimulation of T cells

Question 27

Rituximab MOA

Answer 27

Anti-CD20 | - Causes destruction of B cells

Question 28

Tofacitinib MOA

Answer 28

JAK1 and 3 inhibitor | - Blocks signaling for inflammatory cytokines

Question 29

Seronegative Spondyloarthropathy

Answer 29

Group of inflammatory arthritides which primarily involve ankylosing of the spine that improves with exercise but NOT with rest

Question 30

What extra-articular manifestations can seronegative spondyloarthropathy have?

Answer 30

- Uveitis - GU Tract - Skin

Question 31

What is the typical patient of seronegative spondyloarthropathy?

Answer 31

Caucasian between 16 and 30 yrs

Question 32

What are some pathogenesis theories of seronegative spondyloarthropathy?

Answer 32

- Molecular mimicry following an infection | - Misfolding and dimerization leads to inappropriate stimuli and inflammation

Question 33

What are the important molecules in the pathogenesis of seronegative spondyloarthropathy?

Answer 33

- TNF - IL-17 - important in defense against bacteria but dysregulation leads to joint destruction - IL-23

Question 34

What are some of the effects of IL-17?

Answer 34

 Increase in proinflammatory cytokines  Increase in metalloproteinase  Increase in RANKL activity

Question 35

Sacroiliitis

Answer 35

- Granulation tissue erodes through bone and cartilage into joint cavity - Infiltration of subsynovium: macrophages, lymphocytes, plasma cells - Osteoblasts eventually replace cartilage with new bone which is called ankylosis

Question 36

Spinal Ankylosis

Answer 36

 Spinal inflammation |  Spinal ankylosis

Question 37

Syndesmorphytes

Answer 37

Sclerosising and squaring of the vertebral corners - can lead to complete bridging ossification

Question 38

What GI disease is seronegative spondyloarthropathy associated with?

Answer 38

- Crohn's Disease | - Ulcerative Colitis

Question 39

What type of arthrtitis will have pain increase throughout the day after weight bearing?

Answer 39

OA

Question 40

What arthritis does smoking have a lot of correlation with?

Answer 40

RA

Question 41

What are the main differences between RA and OA?

Answer 41

RA will often be symmetrical and will affect many joints as well as have extra-articular involvement and inflammatory cells

Question 42

What is the first line biologic for RA?

Answer 42

Anti-TNF alpha drugs

Question 43

What are the only biologics that work in spondyloarthropathy?

Answer 43

Anti-TNF alpha drugs