Osteoarthritis + Rheumatoid Arthritis Flashcards
What are the four subtypes of inflammatory arthritis?
Seropositive
Seronegative
Infectious
Crystal induced
What are the seropositive inflammatory arthritis?
Rheumatoid arthritis Connective tissue diseases: - Lupus - Scleroderma - Vasculitis - Sjogren's
What are the seronegative inflammatory arthritis?
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
IBD arthritis
Describe the pain + stiffness seen in osteoarthritis
Mechanical pain–> worse on activity, relieved by rest
(may eventually be present at rest or at night)
Usually morning stiffness lasting < 30 minutes
–> inactivity gelling
What are the common sites for OA?
Cervical spine, lumbar spine, hip, knee
Foot –> MTP joint
Hand –> DIP, PIP, 1st IP, 1st MCP, CMC
Which general findings may bee seen on examination of an OA joint?
Crepitus
Joint swelling –> bony enlargements due to osteophytes
Joint tenderness/effusion
Which bony enlargements may be seen in OA fingers?
DIPs –> Heberdens nodes
PIPs –> Bouchards nodes
Which findings may been seen on examination of an OA knee?
Effusion
Crepitus
Reduced ROM
Bakers cyst
How might pain present in an OA hip?
Pain in groin, radiating to the knee
How is OA diagnosed?
Clinical + xray
What are the X-ray findings in an OA joint?
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
What are the non-pharmacological management options for OA?
Explanation Physio --> muscle strengthening Weight loss Exercise Trainers, insoles, walking stick
What is the step wise approach to pharmacological management of OA?
- Paracetamol + topical NSAIDs
- Topical capsaicin for knee or hand
- Oral opioids
- Oral NSAIDs/COX-2 inhibitor
- Intra-articular steroids
What are the cardinal features of an inflammatory arthritis?
Joint pain + swelling Morning stiffness > 30 mins Improvement with exercise Synovitis on examination Raised inflammatory markers (CRP +PV) Extra-articular symptoms
What is the main structure involved in RA?
Synovium (lines joint capsules and tendon sheaths)
Describe the pathophysiology in RA?
Inflammation of synovium –> joint destruction, tendon ruptures and soft tissue damage –> joint instability and subluxation
What are the primary clinical features in RA?
Rapid onset
Symmetrical synovitis (doughy swelling)
Morning stiffness > 30 mins
Which joints are most commonly affected in RA?
Small joints of hands and feet
–> PIPs, MCPs and MTPs (NOT DIPs)
What are some examination features of RA?
Doughy swelling of affected joints
Positive compression tests of MCP and MTP joints
Later:
- Deformities
- C-spine affected –> altlanto-axial subluxation
- Tendon ruptures
Which deformities may develop in the hands of someone with RA?
Boutonniere deformity
Swan-neck deformity
What are some of the extra-articular features of RA?
Rheumatoid nodules (extensor surfaces or sites of frequent mechanical irritation)
Lungs –> effusions, interstitial fibrosis, pulmonary nodules
Increased risk of CVD
Eyes –> keratoconjunctivitis sicca, episcleritis, uveitis
Which blood test results may be seen in RA?
Autoantibodies: - anti-CCP (most specific so preferred test) - rheumatoid factor Increased inflammatory markers: - CRP, ESR and plasma viscosity
What are the xray findings in RA?
Early –> normal, soft tissue swelling, peri-articular osteopenia
Late –> erosions, subluxations
Which mode of imaging may be useful in RA before xray features are present?
USS –> shows synovitis in early disease
What are the principles of RA management?
Early DMARDs --> within 3 months of symptom onset Education Symptom relief STOP SMOKING Screen for CVD and osteoporosis
What is the first line DMARD used in RA and name 3 others?
Methotrexate first line
Sulfasalazine, leflunomide, hydroxychloroquine
What are some side effects associated with the DMARDs used in RA?
Bone marrow suppression Infection Deranged LFTs Pneumonitis Nausea
Which drugs are used for symptom relief in RA?
Paracetamol
NSAIDs
IM/intra-articular steroids
Oral steroids (short term for flares)
What is the criteria for starting biologic therapy for RA?
Tried 2 DMARDs + DAS 28 score > 5.1
What are some of the risks associated with biologics?
Increased risk of infection especially TB
? risk of skin cancer
In which conditions are biologics contraindicated?
Pulmonary fibrosis
HF
What is the DAS 28 score and which 4 domains are included?
Measure of disease activity in RA
- tender joint count
- swollen joint count
- CRP/ESR
- visual analogue score (patient’s own assessment)
Which DAS28 score indicates remission and which indicates high disease activity?
Remission - < 2.6
High disease activity - > 5.1
