Osteoarthritis and Rheumatoid Arthritis

Question 1

What are the clinical, laboratory, and imaging findings of OA?

Answer 1

Clinical
* > 50 y/o
* morning stiffness < 30 minutes
* no inflammation
* bony enlargement and tenderness
Laboratory
* ESR < 40
* RF < 1:40
Imaging
* Osteophytes
* Joint space
* Subchondral Cysts
* Malalignment

Question 2

What are features of generalized OA?

Answer 2

 AD, occurs more in post-menopausal ♀
 Knee and weight bearing joints are first
 Heberden’s nodes (DIP) and Bouchard’s nodes (PIP)
 Palpable cysts in DIP
 Cyst 1stCMC
 Cervical spine/knees
Space
 occasionally&raquo_space; episodes of painful inflammation of PIP or DOP.
Space
 Called inflammatory (erosive) OA when bony erosions are visible on XR

Question 3

How does OA manifest in the spine?

Answer 3

Disc disease with osteophytes and facet OA

Question 4

What are the causes of Secondary OA?

Answer 4

Inflammation, endocrine, metabolic

Question 5

What are causes of symmetrical secondary OA?

Answer 5

	Inflammatory arthritis
	Hemochromatosis >> Think of it when seeing OA of the MCPs, esp in a younger pt
	Calcium pyrophosphate disease (CPPD)
	Acromegaly
	Wilson's Disease
	Ochronosis

Question 6

What are causes of monoarticular secondary OA?

Answer 6

 Avascular necrosis
 Congenital problems (Congenital Hip Disease)
 Trauma

Question 7

What are Tx for OA?

Answer 7

NSAIDs and lifestyle

Question 8

What is the mechanism for RA?

Answer 8

HLA-DR mutation increases the risk for Anti-Citrullinated Protein Antibody.
RF is also a factor, but not specific
APCA forms immune complexes&raquo_space; complement, macrophages, TNF-a and IL-6&raquo_space; synovium turns to lymph tissue&raquo_space; “Panus”&raquo_space; Fibrous/bony ankylosis, weakening scarring of periarticular structures&raquo_space; deformities

Question 9

What is Pannus?

Answer 9

Pannus is a medical term for an abnormal layer of fibrovascular tissue or granulation tissue. Common sites for pannus formation include over the cornea, over a joint surface (as seen in rheumatoid arthritis), or on a prosthetic heart valve. Pannus may grow in a tumor-like fashion, as in joints where it may erode articular cartilage and bone.

Question 10

What is the clinical presentation of RA?

Answer 10

Polyarticular joint involvement
Symmetrical
Hands (90%)
Acute or progressive
Inflammatory&raquo_space; morning stiff, improves with use
Global symptoms > fatigue, fever, malaise

Question 11

What are Physical Exam findings in RA?

Answer 11

Early: 
* Hands 2/3rd MCP and MTP
* joint inflammation, erythema, swelling, effusions, RA nodules
Late: 
* loss of motion
* Deformities: 2nd MCP subluxation and ulnar drift. 
* Swan-neck Boutoniere
* Claw hand maneuver
* Wince when shake hand >> Dx

Question 12

What are lab findings of RA?

Answer 12

Anemia of chronic disease common
inc. ESR and CRP
Synovial fluid: WBC > 1000, turbid
RF in 70%, but non-specific
ACPA 85% and specific

Question 13

What is imaging for RA?

Answer 13

soft tissue swelling

joint erosions, loss of joint space

Question 14

What is Tx for RA?

Answer 14

DMARDs

Question 15

What are DMARDs?

Answer 15

Disease Modifying Antirheumatic Drugs
	MTX is first line (except drinkers and preg)
	Prednisone
	Hydroxychloroquine (not if eye disease)
	Lefluonomide/SSZ
	TNF, IL-6R (Cytokine antagonists)
	Rituximab (anti-CD20)
	INF (IFN-α)
	CTLA-4 Ig

Question 16

What are connections with RA?

Answer 16

Felty's Syndrome: leukopenia, spleenomegaly, leg ulcers
Nerve entrapment: ex carpal tunnel
Pulm fibrosis, nodules
Pericarditis
Eyes when RA + Sjorgen