Osteoarthritis + RA

Question 1

Prevalence for hip + knee

Answer 1

11% hip

24% knee

Question 2

Pathology of OA

Answer 2

Loss of cartilage, remodelling of adjacent bone + associated inflammation

Question 3

RF for OA

Answer 3

Genetic 
Ageing
Females
Obesity 
Joint injury 
Reduced muscle strength
Joint laxity + misalignment

Question 4

Symptoms of OA

Answer 4

Joint pain exacerbated by exercise
Hip OA = felt in groin + anterior/ lateral thigh
Joint stiffness in morning + after rest
Reduced function

Question 5

Signs of OA

Answer 5

Reduced range of movement 
Pain on movement 
Joint swelling
Crepitus 
Bony swellings due to osteophytes

Question 6

Management of OA

Answer 6

Exercise 
Physio
Weight loss 
Topical NSAIDs + paracetamol 
Intra-articular corticosteroid injections 
Refer for surgery if not responding

Question 7

RF for RA

Answer 7

Female 
Smoking 
HLA-DR1 linked 
Winter onset 
High birth weight 
Obesity 
DM

Question 8

Pathology of RA

Answer 8

Chronic, autoimmune systemic inflammatory disease

Symmetrical, deforming, peripheral polyarthritis

Question 9

Symptoms of RA

Answer 9

Fatigue, flu, fever, sweats, weight loss
Insidious symmetrical polyarthritis, commonly in small joints of hands and feets
Heat, redness, swelling, pain, stiffness (especially in morning or after rest)
Progressive deformity + disability

Question 10

Signs of RA

Answer 10

Muscle wasting + tendon rupture

Ulnar deviation, swan neck + Boutonniere’s deformity, Z deformity of thumb + piano key deformity of wrist

Question 11

Other manifestations of RA

Answer 11

Eyes: secondary Sjogrens syndrome, scleritis, episcleritis
Leg ulcers + rashes
Rheumatoid nodules on eyes, subcut, heart, lung
Vasculitis, valvulitis, fibrosis

Question 12

Investigations for RA

Answer 12

Rheumatoid factor positive in 70%
Inflammation = high platelets, high ESR, high CRP
Positive anti-CCP + negative ANA
FBC: normochrmoic, normocytic anaemia

Question 13

X Ray findings for RA

Answer 13

Soft tissue swelling, juxta-articular osteopenia + decreased joint space
Bony erosions, sublucation + carpal destruction

Question 14

Management of RA

Answer 14

Early use of DMARDs eg methotrexate, sulfasaline, hydroxychloroquine
Biological agents (TNF alpha inhibitors = infliximab)
Steroids to reduce symptoms + inflammation = methylprednisolone
NSAIDs for symptomatic relief

Question 15

Complications of RA

Answer 15

Immunosuppression - neutropenic sepsis

Vasculitis, lymphadenopathy, dry eye syndrome, neuropathy, Felty’s syndrome (enlarged spleen + low white cell count)

Question 16

Complications of DMARDs

Answer 16

Methotrexate = pneumonitis, oral ulcers, hepatotoxicity 
Sulfasaline = rash, low sperm count, oral ulcers 
Hydroxychloroquine = irreversible retinopathy

Question 17

Complications of biological agents used to treat RA

Answer 17

Infections, reactivation of TB, worsening HF, hypersensitivity, blood disorders

Question 18

Differentials for back pain

Answer 18

Sciatica 
Sacro-iliac joint dysfunction 
Cauda equina 
Fractured vertebrae 
Bone mets 
Ankylosing spondylitis (young males)

Question 19

What is a yellow flag?

Answer 19

Psychosocial factors indicative of long term chronicity + disability