RA/OA/Fibro Flashcards
Rheumatoid Arthritis
Autoimmune disease - chronic and systemic inflammatory dis
primarily involving the synovial joints
W>M btw 35-50yrs
-unknown etilogy
RA clinical Features
- Symetrical polyarthritis
- porgress periphery to more proximal
- axial skel usually spared (exept cervical spine)
- Gradual onset
- may also have mysalsgias, fatugue, fever, sleep trouble
RA sx
Pain, stiffness, swelling of many joints
- small joints of hand wrist and forefoot most common
- morning stiffness!! > 1hr and gets better with movement
RA physical exam
- Joint inflammation
- tenderness to palpation
- Swelling and palapable synovial thickening
- SPARES DIP joints!!
RA hand
Sym MCP PIP -reduced grip strength - flexor tendon tenosynovitis "trigger finger" - swan neck or boutonniere deformities *ulnar deviation
RA UE finding
Wrist: loss of extention and carpal tunnel**
Elbow:
loss of ext and ulnar nerve compression and Rhuematoid nodules
Should: frozen shoulder
RA LE
Feet: MTP joints> callus formation, hallux valgus, hammer toes Kneed: effusion limited ROM *Popliteal(Bakers cyst) Hips: restriction
RA extrareticular manifestations
Skin: subcutaneous nodules Eye: scleritis, Seconfary Sjorgens synd Pulm: pleural effusion, pleuritis CV: **accelerated cardiovascular disease MSK: osteoporosis Felty syndrome: trias of RA splenomegaly and neutropenia
RA lab testing
Rheumatoid Factor anti-ccp antibodies -most specific for RA ANA CBC - look for anemia, leukocytosis, thrombocytosis ESR/CRP synovial fluid
RA tx
Early dx and refered
-Early use of DMARDs> treat to target
- Non biologic, biologics, JAK inhibit
Antiinflammatory agents only as adjusts to therapy
- maintain muscle strength and joint allignment
Osteoarthritis OA Pathogenisis
Biochemical breakdown of auticular cartilage
all joint tissues are involved not jus cartilage
Risk: ages, injury, gen, obesity, gender, joint shape
- porgressive joint narrrowing
- synovial inflammation
-osteophytes
- thickening of subconfral bone
OA sx
joint pain, stiffness, locomotor resistance
- worse with joint usage
- relived by rest
- in later stage may be morning stiffness <30min
OA exam findingss
tenderness to palpation - reduced ROM Bonuy enlagemtn -joint deformity in advanced damage - instability
OA hand pres
- bilateral
- Heberdens (DIP) node
- Bouchards(PIP) nodes
- first carpometacarpal joint often “squared of”
OA Knees/hips
Knee: bilateral, joint tenderness, crepitus, limit ROM Hip: -unilateral - restricted ROM -pain around hip and groin
OA imaging
Xray
- see narrowing of the joints
- may see the bone spurs
OA managment
Non pharm: excercise programs, weight loss, PT/OT, assistaed deviced when needed
Pharm:
Oral/topical NSAIDs, topical capsaicin, DUloxetine, Tramadol, Acetaminophen, Intrarticular injections, glucosamine
Surgical: joint
Polymyagia Rheumatica PMR
Chronic inflammatory condition
- proximal aching and stiffness
- shoulder neck and pelvic girdle
- morning stiffness >1hr
- predominantly >50
- associated with giant cell arteritis
PMR presentation
Bilateral involvment
Shoulder and pelvic girdle pain
aching or stiffness> synovitis, tenosynovitis, bursitis
-commonly subdeltoid and subacromial bursitis
- often a sudden progression
-Morning stiffness
PMR physical exam
- Limited ROM (part abduction of arms)
- normal muscle strength
- peripheral synocvitis
PMR diagnostic
- Elevated ESR >40mm/hr
- check CRP
- may see normocytic anemis
- neg ANA, RF, anti CPP abx
- imaging to confirm bursitis/synovitis
PMR dx citeria
> 50 yo
- proximal and symetrical aching and morning stiff
- elevated ESR
- rapid resolution with low dose glucocorticoids
PMR tx
Glucocorticoids 10-20mg/day
if cannot then MTX
Fibromyalgia
widespred MSK pain and fatigue and cognitive distrubances, psych sx, and somatic sx
-cause is unknown
W>M
-20-50
- co-occurs with RA and SLE
may be a disroder of central pain processing
FM clinical manifestations
-fatigue and poor sleep
-widepread often bilateral pain
- “fibro fog” cognitive dist
- also may have depression/anxiety
Somatic:
HA, pelvix pain, IBS, IC, sleep apnea, restell leg syndrome
>3mo
FM dx
- multiple soft tissue tenderness with NO soft tissue or joint swelling
- no lab or imaging abnormalities
Eval for coexisting condition - CBC, ESR, TSH, sleep study
- dx from absense of other sytemic condtions accoutning for pain
FM non pharm
Excercise PT Cognitive behavioral therapy - sleep hygeine, relaxation Pharm: - Tricyclic antidepresents : - SNRI's -Anticonvulsants
