Osteoarthritis and Rheumatoid arthritis

Question 1

Name signs of osteoarthritis

Answer 1

Heberden's (DIP) and Bouchard's (PIP) nodes
Bony/hard nodules
Squaring of CMC joint of the thumb
Crepitus on joint movement
Restricted RoM

Question 2

Name symptoms of osteoarthritis

Answer 2

Pain on exertion, relieved by resting
Morning stiffness lasting less than 30 minutes
Constant pain (including at night)
Joints affected: DIPs, PIPs, CMC of thumb, knees, hips

Question 3

What are the radiological findings of osteoarthritis on Xray?

Answer 3

LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

Question 4

What is the management of osteoarthritis?

Answer 4

General: Weight loss, physiotherapy, exercise
Pharmacological: Topical/oral analgeisa, Intra-articular corticosteroid joint injections
Surgery: Joint replacement

Question 5

What is rheumatoid arthritis?

Answer 5

Chronic AI disorder affecting synovial joints with symmetrical polyarthropathy and extra-articular features

Question 6

What are the risk factors for RA?

Answer 6

Female
30-50
HLA-DR4 and HLA-DR1 genotypes
Smoking
FHx

Question 7

Describe seropositive and seronegative RA.

Answer 7

Seropositive: RF and/or anti-CCP present, more common
Seronegative: Ab levels not detectable. Diagnosis made based on clinical symptoms and imaging showing bone/cartilage destruction

Question 8

What are symptoms of RA?

Answer 8

Morning stiffness lasting more than an hour
Improves with use of joints
Tender, erythematous, swollen joints
Joints affected: MCPs, PIPs, wrist, MTPs, Cervical spine (DIP sparing)

Question 9

What are signs of RA?

Answer 9

Boggy joints
Pain on movement
Positive MCP squeeze test
Limited ROM
Rheumatoid nodules (achilles tendon, elbow)

Question 10

What hand and foot signs are seen in RA?

Answer 10

HAND: Ulnar deviation, loss of guttering between knuckles, interosseus muscle wasting, subluxation of MCPs, swan neck and boutonniere deformities, z shaped thumb
FOOT: Hallux valgus, hammer toe, claw toe, bursae and calluses on sole

Question 11

What are extra-articular features of RA?

Answer 11

Anaemia of chronic disease
Lymphadenopathy
Pleurisy, fibrosis, effusion
Vasculitis
Rheumatoid nodules on elbows and lungs
Episcleritis, scleritis, keratoconjunctivitis sicca (dry eyes)
Osteoporosis
Raynaud’s, carpal tunnel, peripheral neuropathy
Pericardial effusion
Felty’s syndrome (RA+splenomegaly+neutropenia)

Question 12

What do investigations of RA show?

Answer 12

Blood: Anaemia, raised ESR/CRP, Rheumatoid factor, Anti-cyclic citrullinated peptide
X-ray: Marginal erosions (rat bits), joint space narrowing, periarticular osteopenia, soft tissue swelling

Question 13

What is the management of RA?

Answer 13

Acute: NSAIDs, Steroids
Long term: Aim for remission or low disease activity
1st line- DMARD monotherapy
Dual DMARD therapy if target is not reached (must have tried methotrexate)
2nd line- Biologic therapy

Question 14

Name 4 DMARDs and their side effects

Answer 14

Methotrexate
Side-effects: pneumonitis (within months of starting treatment), myelosuppression, liver cirrhosis, teratogenicity
Sulfasalazine
Side-effects: myelosuppression, skin rashes, oligospermia, heinz body anaemia, interstitial lung disease
Hydroxychloroquine
Side-effects: retinopathy (annual eye screening)
Leflunomide
Side-effects: myelosuppression, liver impairment, interstitial lung disease, hypertension

Question 15

Name types of biological therapy

Answer 15

Anti-TNFa, Anti-B cell, Anti-IL6, Anti-T cell, JAK inhibitors