Osteoarthritis + RA - 405 Flashcards
osteoarthritis (OA)
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
osteophytes
in pts w/ OA, the bones can grind together causes bone spurs aka osteophytes
OA vs RH: when sx start
OA: after 40 yrs
RH: young to middle age
commonly affected body parts w/ OA
-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
less commonly affected body parts w/ OA
-shoulder
-wrist
-elbow
-knuckles at base of fingers
symptoms of OA
-joint pain
-stiffness
-cracking or clicking
-extra bone growth
-decreased ROM
-problems with joint alignment
-tender to touch
OA pain & stiffness characteristics
-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
deformities associated w/ OA
-heberden’s & bouchard’s nodes on fingers
-bowlegged appearance
how to dx OA
-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
what is the foundation to OA management
non drug interventions
non drug interventions for OA
-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
OA drug therapy
-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
joint injections for OA
-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
hypaluronate injections
-substance in joint that allows joint fluid to be slippery
-S/s same as steroids
-usually reserved for pts waiting for a joint replacement
who to consult for OA
-rheumatologist
-physical therapist
-occupational therapist
-nutritionist
early sx of RH
systemic
fatigue, anorexia, wt loss, generalized stiffness
progression sx of RH
pain, worsening stiffness, limited motion, deformities and disabilities
pain & stiffness characteristics of RH
-morning stiffness lasting >60mins
-remissions & exacerbations
deformities w/ RH
-rheumatoid nodules & sjogren’s syndrome
-ulnar deviation
-knuckle subluxation (partial dislocation)
-wrist subluxation
-finger swan neck
-finger boutonniere
-z shaped thumb
Sjogren’s syndrome
-diminished lacrimal secretions (ocular & oral) causing burning, gritty, itchy eyes and decreased tears + dry mouth
-photosensitivity
-also seen in lupus
rheumatoid nodules
subq, non tender, firm nodules that are usually located in the fingers and elbows
joint characteristics OA vs RA
OA: hard & boney
RA: soft, warm & tender
labs OA vs RH
OA: neg RF, neg anti CCP & normal ESR & CRP
RH: pos RF, pos anti CCP & elevated ESR & CRP
primary joints OA vs RH
OA: distal interphalangeal & carpometacarpal
RH: metacarpophalangeal & proximal interphalangeal
dx of RH
-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
RH collaborative care
-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
what is the foundation of treatment for RH
medications
goal: achieve remission & prevent further joint damage, without causing unacceptable side effects
medications for RH
-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)
DMARDs
methotrexate & hydroxychloroquine
methotrexate
improvement of sx in 4-6 weeks
often used in early RH (start asap to lessen permanent effects)
hydroxychloroquine
improvement in 2-3 months
OA vs RH: effusions
OA: uncommon
RH: common
OA vs RH: synovial fluid
OA: wbc <2000 (mild leukocytosis)
RH: wbc >20000
OA vs RH: xrays
OA: joint space narrowing, osteophytes, subchondral cysts, sclerosis
RH: joint space narrowing, erosion, subluxation, osteoporosis
Rheumatoid Arthritis
an autoimmune, symmetrical, progressive and insidious disease that causes inflammation of the connective tissue in the synovial joints
