RA, OA, PMR And Fibromyalgia Flashcards
Should we give opioids for fibromyalgia
No
Name it:
Subchondral bone thickening with degeneration of cartilage
OA
What is the most specific autoantibody for RA
Anti CCP
Specificity is 90-98%
What will the labs look like in PMR
Elevated ESR
Will people with RA have trouble opening jars?
Yes, they have reduced grip strength and ROM
How long does morning stiffness last with RA and what makes it better?
Lasts over an hour and gets better with movement
Is the onset of polymyalgia rheumatica progressive or sudden?
Sudden***
What kinds of external triggers might wake up a genetic predisposition for RA?
SMOKING
Name it:
Enthesitis with chronic inflammation
Ankylosing Spondylitis
What is the most common inflammatory arthritis?
RA
What are the primary joints affected in RA?
MCP and PIP
What is the main nonbiologic DMARD used in RA
Methotrexate
Name it:
More common in women
Chronic, generalized pain
Fatigue
Sleep and mood disturbances
Headaches
IBS
Multiple tender areas
No inflammatory muscle or joint disease
Labs unremarkable
Fibromyalgia
What are the main types of biologic DMARDs used in RA?
TNF inhibitors
Non-TNF inhibitors
What is the treatment of RA?
DMARDS in all patients
Quit smoking
PT/OT
Rest if needed
NSAIDS
What are the primary joints affected in OA?
DIP
1st CMC
Is RA symmetrical
Yes**
Does the joint space narrow in OA
Yes and it can be seen on x ray
What is the treatment for PMR?
Low dose steroids!!
PROFOUND RESPONSE
How do DMARDs help RA
Slow/halt disease progression and preserves joint function
What will you see on an X-ray of OA
Joint space narrowing
Osteophytes ***
How do you treat OA
Weight loss **
Oral and topical NSAIDs
Topical capsaicin
Cymbalta
Steroid injections
Tramadol
Tylenol
Opioids sparingly if at all
**know all of these
What causes the compression on the cervical spinal cord in RA
Inflammation (?)
“I hurt all over”. “It feels like i always have the flu”
Fibromyalgia
What is the most common joint disorder
OA
Is the DIP joint affected in OA
Yes
Are there any specific labs for OA
No
Negative RF and anti-CCP
Normal ESR and CRP
How long will morning stiffness last in OA
Less than 30 min
What is the difference between OA and greater trochanteric pain syndrome
GTPS will usually be more lateral with point tenderness
What is a pathognomic sign of OA
Osteophytes (bone spurs)
What is seronegative RA?
RA that lacks both RF and anti-CCP antibodies but otherwise is characteristic of RA in every other way
Is RA a gradual onset
Yes, RA pts will have gradual difficulty with ADL’s like walking, dressing, toileting, etc
Is carpal tunnel syndrome a complication of RA?
Yes because the inflammation makes the tunnel smaller
Is osteoarthritis an autoimmune disease?
No it is a degenerative disease
Is CAD associated with RA?
Yes, the inflammation may increase atherosclerosis
Which has extra-articular manifestations: OA or RA?
RA
What is the preferred initial imaging study for RA
X ray
Which type of arthritis causes an inflamed synovium?
RA
Who should be tested for RA?
Have at least 1 joint with definite synovitis
Synovitis not better explained by another disease
Is OA usually symmetrical or asymmetrical
Asymmetrical
What is it:
Autoimmune disease that is chronic, systemic, inflammatory that primarily involves the synovial joints with extraarticular manifestations
RA
“No matter how much i sleep, it’s like i got hit by a truck”
Fibromyalgia
-they always feel unrefreshed even after sleeping for 8-10hrs
How will the joints appear in OA
Hard and bony
Name it:
Synovial hypertrophy with chronic joint inflammation
RA
Is OA just wear and tear of the cartilage
No, it involves all of the joint tissues (cartilage, bone, ligaments and synovium)
“I suddenly can’t brush my hair or put on my bra or pull shirt over my head”
Polymyalgia rheumatica
Does RA involve constitutional symptoms like fatigue, myalgia, fever, weight loss
Yes
Which way do the fingers deviate in RA
Ulnar
When would we use MRI in the assessment of RA
When looking at cervical spine
What are all the things you need to know about PMR
- women
- over 50
- steroids are 1st line- profound response
- sudden, recent change
- giant cell arteritis
- elevated ESR
What are the classic symptoms in classic locations for RA
Pain, stiffness and swelling
In the small joints of the hands, wrists and forefoot
What are the 2 types of DMARDS
Nonbiologic “traditional”
Biologic
Does OA affect the synovial membrane or the soft tissue components of the joint?
Yes
What condition is polymyalgia rheumatica associated with
Giant cell (temporal) arteritis ********
Which has more morning stiffness: RA or OA?
RA
Why do you need to order both RF and anti-CCP labs for RA?
One or the other may be negative, but if they are both positive, it really suggests RA
Does RA affect the DIP joints?
NO!!!*******
What is Felty syndrome and what causes it?
It’s a triad of RA, splenomegaly and neutropenia
*******
How does RA cause cervical myelopathy?
The C1 - C2 joint is unstable and may subluxate causing impingement on the cord
Which type of arthritis has Heberdens nodes?
OA
What is it:
Progressive loss and destruction of cartilage****
OA
CARTILAGE EROSION
BONE SPURS
RA usually spares the axial skeleton, except for which part?
The cervical spine! C1 and C2
How will the joints appear in RA?
Soft
Warm
Tender
What is the most common site for rheumatoid nodules to appear
Elbow
What kinds of bony changes will be seen in the joint in OA
Bone sclerosis (bone thickening)
Osteophytes (bone spurs)
What 2 labs do you need to order when diagnosing RA
Rheumatoid factor
Anti-CCP antibodies
Who is more likely to get polymyalgia rheumatica
Women of Northern European descent over 50
When should DMARDs be started in RA
As early as possible
What are some controversial treatments for OA
Intrarticular hyaluronic acid
Glucosamine/chondroitin
How does RA affect the popliteal fossa
Bakers cysts common
What is the nonpharmacologic treatment for fibromyalgia
Exercise (especially water aerobics)
PT
Behavioral therapy
Is secondary Sjögren’s syndrome a manifestation of RA
Yes
Which type of arthritis involves cartilage loss
OA
Do you see swan neck and boutonnière deformities in RA?
Yes
What will you see on X-ray of RA
PIP joint erosions
Periarticular osteopenia
Joint space narrowing
Soft tissue swelling around joint
What is it:
Proximal** aching and stiffness in the shoulder, pelvic girdle and neck
Over 50 years old
Women of Northern European descent
Polymyalgia rheumatica (PMR)
How does RA affect the feet
Common to see bunions and hammer toes
What is thought to cause the symptoms of polymyalgia rheumatica?
Nonerosive synovitis and tenosynovitis
Is fibromyalgia true inflammation
No
What makes OA worse and what makes it better?
Activity makes it worse
Rest makes it better
What will analysis of the synovial fluid in RA reveal?
Inflammatory effusion
What is the leading cause of chronic disability in old people
OA
How does the pain present in polymyalgia rheumatica (PMR)
Sudden
Bilateral
Shoulders and hips
Morning stiffness/gel phenomenon
What do you need to do before starting DMARDs?
Check a bunch of labs, give them vaccines, check their eyes and test for TB since the medication can cause malignancy/infection
What are the classic findings on the hands in OA
Bilateral
Heberdens nodes
Bouchards nodes
First carpometacarpal joint
Often “squared off” due to CMC having osteophytes
What is the treatment for fibromyalgia
Antidepressants- amitriptyline
Anticonvulsants - gaba
SNRIs- cymbalta or savella
What are the locations of the joints usually affected by RA?
Many joints on both sides, starting with the peripheral joints to more proximal.
Axial skeleton spared except for cervical spine
When does the stiffness of OA get worse?
After effort
“Evening stiffness”
Who usually gets RA?
Women between 35 and 50
What are two words you can use to describe the swollen joints of RA?
Boggy
Fluctuance
What is a marker of disease severity in RA?
How many extraarticular manifestations you have
What parts of the spine are affected in OA
Cervical and Lumbar
RA was just cervical
What makes RA worse and what makes it better?
Rest makes it worse
Activity makes it better
