Osteoarthritis (OA) & Rheumatoid Arthritis (RA) Flashcards
Define Osteoarthritis
- Disabling joint disease is characterized by non-inflammatory degeneration of the joint complex (articular cartilage, subchondral bone, and synovium).
- A condition characterized by the progressive loss of articular cartilage and remodeling of the underlying bone.
Symptoms of Osteoarthritis
Pain Stiffness Tenderness Loss of flexibility Bone spurs (Osteophytes) Swelling
Pathophysiology of Osteoarthritis
The pathogenesis of OA involves degradation of cartilage and remodeling of bone due to an active response of chondrocytes in the articular cartilage and the inflammatory cells in the surrounding tissues.
The release of enzymes from these cells breaks down collagen and proteoglycans, destroying the articular cartilage. The exposure of the underlying subchondral bone results in sclerosis, followed by reactive remodeling changes that lead to the formation of osteophytes and subchondral bone cysts. The joint space is progressively lost over time.
(Chronic mechanical stress on the joints & aging = decrease in proteoglycans = cartilage loses elasticity and becomes friable = joint space narrowing and thickening and sclerosis)
Define Sclerosis of bone
Abnormal increase in density and hardening of bone
Define Rheumatoid Arthritis (RA)
- A chronic, systemic, inflammatory autoimmune disorder that primarily affects the joints; but may also manifest with extraarticular features.
- The immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.
Symptoms of Rheumatoid Arthritis (RA)
Joint pain, swelling, and stiffness. It may also cause more general symptoms (tiredness and a lack of energy, high temperature, sweating, poor appetite
weight loss) and inflammation in other parts of the body.
Clinical features of Rheumatoid Arthritis (RA)
OR
Deformities caused by Rheumatoid Arthritis (RA)
(a) Swan neck deformity
- caused by hyperextension of the proximal interphalangeal joint, together with flexion of the distal interphalangeal joint and occurs as a result of an imbalance between the component parts of the extensor and flexor mechanism: it may be related to problems at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints.
(b) Boutonniere deformity
- flexion deformity of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint.
The main difference between Osteoarthritis (OA) and Rheumatoid Arthritis (RA)
The main difference between osteoarthritis and rheumatoid arthritis is the cause of the joint symptoms:
- Osteoarthritis is caused by mechanical wear and tear on joints.
- Rheumatoid arthritis is an autoimmune disease in which the body’s own immune system attacks the body’s joints.
Non-pharmacological treatments for Osteoarthritis
- Lifestyle measures (maintaining healthy weight & exercising regularly)
- Supportive therapies
(1) Hot or cold packs
(2) Assistive devices = special footwear, stick or cane (walking aid)
(3) Manual therapy = technique where a physiotherapist uses their hands to stretch, mobilize and massage the body tissues to keep the joints supple and flexible. - Surgery
(1) Joint replacement = surgeon will remove the affected joint and replace it with an artificial joint (prosthesis) made of special plastics and metal.
(2) Joint fusing = fusing a joint in a permanent position resulting in a stronger and less painful joint. However, a person will no longer be able to move it.
(3) Osteotomy = adding or removing a small section of bone either above or below your knee joint.
Pharmacological treatments for Osteoarthritis
Pain relief medicine:
(1) NSAIDs
(2) Steroid injections
(3) Opioids
(4) Capsaicin cream
Difference between Inflammatory Arthritis and Non-inflammatory Arthritis
Inflammatory Arthritis — Inflammatory arthritis usually causes joint stiffness with rest, especially morning stiffness. Certain types of inflammatory arthritis, such as rheumatoid arthritis and the arthritis of systemic lupus erythematosus (SLE), affect joints symmetrically (ie, affect the same joints on both sides of the body).
Noninflammatory arthritis — Noninflammatory arthritis usually causes pain that is aggravated by movement and weight-bearing and is relieved by rest. Joints on one or both sides of the body may be affected.
Diagnosis of Arthritis
- The process of diagnosing arthritis involves several steps. A medical history and physical examination usually provide the most helpful information; laboratory tests (such as blood and urine tests), imaging tests (such as x-rays), and other tests are sometimes needed.
Joint aspiration / Arthrocentesis
- Testing of the fluid inside a joint (synovial fluid), is often helpful to determine the cause of a person’s arthritis. After making the skin numb, the fluid is removed by inserting a needle inside the joint and withdrawing a sample of fluid.
- Analysis of the joint fluid is particularly helpful in confirming that the arthritis is inflammatory and in establishing if the joint is infected (septic arthritis) or if crystals are present (gout or pseudogout).
X-rays
- Provide detailed pictures of bones.
- Plain x-rays show the bony structures of a joint and are therefore useful for detecting bone damage or other abnormalities.
- Other imaging tests, such as ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT scan), provide images of the tissues inside and surrounding the joints. They provide more detailed information about the bony structures and also show any abnormalities of the soft tissues such as the joint lining, tendons, and bursa.
- One or more of these imaging tests may be recommended to detect erosions (bone damage due to arthritis), fractures, calcium deposits, or inflammation in a joint.
Pharmacological treatment for Rheumatoid Arthritis
Main 2 types: disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments.
(1) DMARDs
- Ease the symptoms of the condition and slow down its progression.
- Work by blocking the effects of the chemicals released when your immune system attacks your joints, which could otherwise cause further damage to nearby bones, tendons, ligaments, and cartilage.
- The DMARDs that may be used include:
methotrexate
leflunomide
hydroxychloroquine
sulfasalazine
- Methotrexate is usually the first medicine given for rheumatoid arthritis, often with another DMARD and a short course of steroids (corticosteroids) to relieve any pain.
(2) Biological treatments
- Such as adalimumab, etanercept, and infliximab.
- Usually taken in combination with methotrexate or another DMARD, and are usually only used if DMARDs have not been effective on their own.
- Given by injection. They work by stopping particular chemicals in your blood from activating your immune system to attack your joints.
Non-pharmacological treatment for Rheumatoid Arthritis
(1) Physiotherapy
(2) Assistive devices
(3) Surgery
(4) Complementary therapies
- acupuncture
- chiropractic
- massage
- osteopathy
Complications of Osteoarthritis
- Chondrolysis = rapid, complete breakdown of cartilage resulting in loose tissue material in the joint.
- Osteonecrosis = bone death
- Stress fractures = hairline crack in the bone that develops gradually in response to repeated injury or stress.
- Bleeding inside the joint.
- Infection in the joint.
- Deterioration or rupture of the tendons and ligaments around the joints, leading to loss of stability.
- A pinched nerve (in osteoarthritis of the spine).
