Pathophysiology of Joint Disease

Question 1

How long does Early Morning Stiffness of the hands last for in Osteoarthritis and in Rheumatoid arthritis?

Answer 1

Rheumatoid arthritis: > 30 mins

Osteoarthritis: < 30 mins

Question 2

In five words, sum up the clinical presentation of Rheumatoid Arthritis

Answer 2

Chronic
Symmetrical
Inflammatory
Deforming
Polyarthritis

Question 3

What is the primary site of inflammation of the Rheumatoid Arthritis?

Answer 3

Synovium

Question 4

State two TNF-alpa inhibiting drugs used to treat Rheumatoid Arthritis

Answer 4

Infliximab

Adalimumab

Question 5

What is “Sarcopenia”?

Answer 5

Loss of skeletal muscle mass and strength as a result of ageing

Question 6

Give examples of three hand deformities as seen as Rheumatoid Arthritis

Answer 6

Swan neck
Boutonniere
Z-deformity of the thumb

Question 7

What cytokines lead to the extra-articular manifestations of Rheumatoid Arthritis?

Answer 7

TNF-a
IL-1
IL-6

Question 8

What joints do Rheumatoid Arthritis typically affect?

Answer 8

MCP / PIP joints

Question 9

Give examples of 3 assays which can be used to support a diagnosis of Rheumatoid arthritis

Answer 9

• Rheumatoid Factor
• Antinuclear antibody
• Anti-CCP / Anti-MCV

Question 10

What HLA-DR serotype is associated with Rheumatoid Arthritis?

Answer 10

HLA-DR4

Question 11

What systemic symptoms are present in Rheumatoid Arthritis?

Answer 11

Fatigue
Low grade fever
Anorexia
Muscle / joint stiffness

Question 12

What systemic symptoms are present in Osteoarthritis?

Answer 12

Absent

Question 13

What is the age of onset for Rheumatoid Arthritis?

Answer 13

20 - 40 years

Question 14

What is the age of onset for Osteoarthritis?

Answer 14

> 50 years

Question 15

What joints are affected in Osteoarthritis?

Answer 15

PIP / DIP joints

Large weight bearing joints i.e. hips / knees / spine

Question 16

Radiologically, what might one see for a patient with Osteoarthritis?

Answer 16

Osteophytes

Joint space narrowing

Question 17

In Osteoarthritis, is the synovial fluid clear or cloudy?

Answer 17

Clear

Question 18

Gout affects what joint of the Hallux?

Answer 18

MTP joint (Podagra)

Question 19

What are five modifiable risk factors for gout?

Answer 19

1. Hyperuricaemia
2. High purine diet (seafoods)
3. Alcohol intake (darker beers)
4. Obesity
5. Medication

Question 20

What medications increase your likelihood of gout?

Answer 20

• Low dose aspirin
• Thiazide diuretics
• Furosemide
• Cyclosporin
• Ethambutol
• Levodopa
• Nicotinic acid

Question 21

Gout is a disorder of what metabolism?

Answer 21

Purine metabolism

Question 22

What gender is more susceptible to Gout?

Answer 22

Males

Question 23

What gender is more susceptible to Osteoarthritis?

Answer 23

Females

Question 24

State the name of 2 drugs used to treat Gout. What is its mechanism of action?

Answer 24

Allopurinol & Febuxostat

Xanthine Oxidase inhibitor

Question 25

What are two complications of gout?

Answer 25

Tophaceous deposits

Renal stones

Question 26

Define septic arthritis

Answer 26

The invasion of a joint by an infectious agent resulting in joint inflammation