Osteoarthritis + RA - 405

Question 1

osteoarthritis (OA)

Answer 1

a progressive disease that involves the formation of new joint tissue in response to cartilage destruction causing low levels of inflammation at the joints
no systemic manifestations
not apart of the the normal aging process

Question 2

osteophytes

Answer 2

in pts w/ OA, the bones can grind together causes bone spurs aka osteophytes

Question 3

OA vs RH: when sx start

Answer 3

OA: after 40 yrs
RH: young to middle age

Question 4

commonly affected body parts w/ OA

Answer 4

-neck & lower back
-joints at base of thumbs
-finger knuckles
-hips
-knees
-joint in the foot above the heel
-knuckle at base of big toe

Question 5

less commonly affected body parts w/ OA

Answer 5

-shoulder
-wrist
-elbow
-knuckles at base of fingers

Question 6

symptoms of OA

Answer 6

-joint pain
-stiffness
-cracking or clicking
-extra bone growth
-decreased ROM
-problems with joint alignment
-tender to touch

Question 7

OA pain & stiffness characteristics

Answer 7

-worsens w/ use, initially relieved by rest
-change in temp or pressure can trigger pain
-stiffness of joints get worse with inactivity
-stiffness in the am, resolves within 30mins
-usually asymmetrical

Question 8

deformities associated w/ OA

Answer 8

-heberden’s & bouchard’s nodes on fingers
-bowlegged appearance

Question 9

how to dx OA

Answer 9

-bone scans, CT, MRI (can show early changes)
-xrays help in staging progression
-no biomarkers
-ESR will be normal (unless synovitis present)
-synovial fluid will be clear yellow & no sign of inflammation

Question 10

what is the foundation to OA management

Answer 10

non drug interventions

Question 11

non drug interventions for OA

Answer 11

-rest/joint protection
-maintain function position prn (orthotic brace)
-avoid prolonged immobilization
-use assistive devices prn
-heat and ice (20 mins on , 20 off)
-weight reduction & aerobic exercise
-yoga, acupuncture, biofeedback
-OTC glucosamine

Question 12

OA drug therapy

Answer 12

-mild to mod: acetaminophen (if lacking signs of inflammation)
-if not relived by above or signs of inflam: NSAIDs
-if problem w/ GI but need NSAIDs: celecoxib

Question 13

joint injections for OA

Answer 13

-glucocorticoid steroids injected to suppress inflammation if unrelieved by other measures & arthritis confined to a few joints
-only provides temporary relief
-can have brief flare after injection
-risk for infection
-no more than 3-4x/yr

Question 14

hypaluronate injections

Answer 14

-substance in joint that allows joint fluid to be slippery
-S/s same as steroids
-usually reserved for pts waiting for a joint replacement

Question 15

Rheumatoid Arthritis

Answer 15

an autoimmune, symmetrical, progressive and insidious disease that causes inflammation of the connective tissue in the synovial joints

Question 15

who to consult for OA

Answer 15

-rheumatologist
-physical therapist
-occupational therapist
-nutritionist

Question 16

early sx of RH

Answer 16

systemic
fatigue, anorexia, wt loss, generalized stiffness

Question 17

progression sx of RH

Answer 17

pain, worsening stiffness, limited motion, deformities and disabilities

Question 18

pain & stiffness characteristics of RH

Answer 18

-morning stiffness lasting >60mins
-remissions & exacerbations

Question 19

deformities w/ RH

Answer 19

-rheumatoid nodules & sjogren’s syndrome
-ulnar deviation
-knuckle subluxation (partial dislocation)
-wrist subluxation
-finger swan neck
-finger boutonniere
-z shaped thumb

Question 20

Sjogren’s syndrome

Answer 20

-diminished lacrimal secretions (ocular & oral) causing burning, gritty, itchy eyes and decreased tears + dry mouth
-photosensitivity
-also seen in lupus

Question 21

rheumatoid nodules

Answer 21

subq, non tender, firm nodules that are usually located in the fingers and elbows

Question 22

joint characteristics OA vs RA

Answer 22

OA: hard & boney
RA: soft, warm & tender

Question 23

labs OA vs RH

Answer 23

OA: neg RF, neg anti CCP & normal ESR & CRP
RH: pos RF, pos anti CCP & elevated ESR & CRP

Question 24

primary joints OA vs RH

Answer 24

OA: distal interphalangeal & carpometacarpal
RH: metacarpophalangeal & proximal interphalangeal

Question 25

dx of RH

Answer 25

-inflammatory arthritis involving 3+ joints
-MCP & PIP joints and also wrist + feet
-pos RF (not specific to RH, seen in 80% pt)
-pos ACPA/anti CCP (more specific & dx can be earlier)
-inc inflam markers
-duration of sx >6wks

Question 26

RH collaborative care

Answer 26

-rest (but physical fitness should be maintained)
-8 to 10 hrs of sleep + a nap
-exercise (even if painful bc not exercising makes it worse)
-ROM
-hand & finger splinting
-PT & OT
-heat (max 20 mins), cold (max 10-15 mins)
-good dietary habits
-biofeedback

Question 27

what is the foundation of treatment for RH

Answer 27

medications
goal: achieve remission & prevent further joint damage, without causing unacceptable side effects

Question 28

medications for RH

Answer 28

-DMARDs -> substantially reduce inflammation of RA, reduce/prevent joint damage, preserve joint structure & function & help maintain activity
-NSAIDS -> immediate relief but do not reduce long term damage & needs to be taken continuously
once DMARDs work, NSAIDs can be stopped
-steroids (not preferred)

Question 29

DMARDs

Answer 29

methotrexate & hydroxychloroquine

Question 30

methotrexate

Answer 30

improvement of sx in 4-6 weeks
often used in early RH (start asap to lessen permanent effects)

Question 31

hydroxychloroquine

Answer 31

improvement in 2-3 months

Question 32

OA vs RH: effusions

Answer 32

OA: uncommon
RH: common

Question 33

OA vs RH: synovial fluid

Answer 33

OA: wbc <2000 (mild leukocytosis)
RH: wbc >20000

Question 34

OA vs RH: xrays

Answer 34

OA: joint space narrowing, osteophytes, subchondral cysts, sclerosis
RH: joint space narrowing, erosion, subluxation, osteoporosis