Osteoarthritis and Rheumatoid Arthritis Flashcards
What is the most common joint condition worldwide?
Osteoarthritis
How does osteoarthritis present?
Similar incidence in men and women
Pain and crepitus on movement.
Worse with prolonged activity
Brief stiffness after rest, takes 10-15mins to get started
Joints may feel unstable
Localised large weight bearing joints, DIP, CMP, PIP
Generalised disease: nodal OA: Heberden’s at DIP and Bouchard’s at PIP
Unilateral symptoms
What do tests show in OA?
LOSS Loss of joint space Osteophytes Subarticular sclerosis Subchondral cysts
X-Rays are first line
What is the management of OA?
Exercise: improve local muscle strength
General aerobic fitness
Weight loss
Regular paracetamol: if ineffective use codeine or topical capsaicin
MDT approach (physiotherapists, OTs)
Surgery: joint replacement
What is the management for osteoarthritis in the hips?
Most common management is a cemented hip replacement. A metal femoral head is cemented into the femoral shaft.
Hip resurfacing is also used where a metal cup is attached to the femoral head
After hip replacement due to arthritis, what do you warn the patient?
- Do not cross your legs
- Avoid flexing your hip >90 degrees
- Avoid low chairs
- Sleep on your back for the first 6 weeks
What are the risk factors for osteoarthritis of the hip?
Increasing age
Female gender
Obesity
Developmental dysplasia of the hip
What is RA?
Autoimmune, chronic systemic inflammatory disease
Symmetrical, deforming peripheral polyarthritis
More common in women
Occurs between 50yrs-60yrs old. Increased in smokers. Increases risk of CVD.
How does RA present?
MCP, PIP joints
Morning stiffness, improves with use
Bilateral symptoms
Systemic upset
Gradually gets worse with larger joints becoming affected
Positive ‘squeeze’ test
Swan neck and boutonnière deformities are late symptoms
What are the X-Ray findings you will see in RA?
'LESS' Loss of joint space Erosions Soft tissue swelling Subluxation
What are the extra-articular manifestations of RA?
Nodules: elbows, lungs, cardiac, CNS, lymphadenopathy
Lungs: pleural disease, interstitial fibrosis, bronchiolitis,
Cardiac: IHD, pericarditis, pericardial effusion, carpal tunnel syndrome
Eyes: keratoconjunctivitis sicca (most common), episcleritis, scleritis, scleromalacia, osteoporosis
What are the investigations for RA?
RF is positive in >70% Anti-CCP is highly specific for RA Anaemia of chronic disease seen Increased platelets Increased ESR & CRP
What is the diagnostic criteria for RA?
Those with >1 swollen joint and a suggestive clinical Hx which is not better explained by another disease
Has to have a score >6
A: Higher points for smaller joints and more joints
B: 3 points for high RF and high positive anti-CCP
C: Abnormal CRP/ESR = 1
D: Duration of symptoms >6w: 1
What is the management of RA?
1) DMARD monotherapy with a short course of prednisolone
Different DMARDs include methotrexate, sulfasalazine, leflunomide and hydroxychloroquine
If at least two DMARDs have been tried and the patient is responding inadequately, give a TNFa inhibitor e.g. infliximab
Rituximab can also be given
What factors indicate a poorer prognosis in RA?
RF and anti-CCP present
HLA DR4
Insidious onset
(Female gender)
What is Felty’s syndrome?
Triad of RA, splenomegaly and neutropaenia
