Rheumatic disease 3

Question 1

What is the most common rheumatic disease

Answer 1

degenerative articular Rheumatic disease
(osteoarthritis)

Question 2

what is osteoarthritis characterised by

Answer 2

by progressive loss of cartilage and reactive changes at the margins of the joint and in the subchondral bone

Question 3

describe the prevalence of osteoarthritis

Answer 3

• disease usually begins in >40s
• prevalence increases with age and disease becomes almost universal in patients aged >65

Question 4

what does osteoarthritis primarily affect

Answer 4

primarily affects weight bearing joints such as knees, hips and lumbrosacral spine

Question 5

what is the cause of degenerative joint disease

Answer 5

cause is unclear
- considered to be a wear and tear arthritis
- frequently associated with obesity
- genetic factors also play role in development (dominant in females)

Question 6

what is the final outcome of degenerative joint disease

Answer 6

full thickness loss of cartilage down to bone
- complete destruction of the joint and surgical intervention is required

Question 7

describe the effects of degenerative joint disease in early stages

Answer 7

in early disease, pain only occurs after joint use and is relieved by rest

Question 8

describe the effects of degenerative joint disease in later stages

Answer 8

as disease progresses, pain occurs with minimal motion or even at rest
- nocturnal pain is commonly associated with severe disease

Question 9

what are the functional limitations of degenerative joint disease

Answer 9

1. limited use of the involved joint
2. walking and transfer activities may be impaired
3. generally, ADLs will not be significantly impaired

Question 10

outline the treatment and prognosis of DJD

Answer 10

1. medication
2. early PT/exercises
3. heat/cold therapy
4. joint protection
5. surgery

Question 11

give an example of a generalised non articular disorder

Answer 11

fibromyalgia syndrome

Question 12

what is fibromyalgia syndrome

Answer 12

a chronic musculoskeletal syndrome characterised by diffuse pain in the absence of synovitis or myositis (muscle inflammation)

Question 13

describe the prevalence of FMS

Answer 13

• 10-12% of general population
• strong female preponderance

Question 14

what is the working model of FMS

Answer 14

1. a disorder of pain processing
2. CNS desensitisation
3. makes usually non painful stimuli feel painful

Question 15

what is the presentation of FMS

Answer 15

1. normal physical examination
2. no significant abnormalities on joint examination
3. characteristic finding is tenderness upon palpation of discrete anatomical locations (tender points)

Question 16

what are the associated complaints of FMS

Answer 16

1. diffuse aching/stiffness which is worse in morning
2. fatigue/exhaustion/sleep disturbance
3. sensation of swelling of hands and feet
4. paresthesias
5. tension headaches/migraines
6. symptoms of IBS
7. anxiety/depression
8. weight gain

Question 17

give examples of local non articular disease

Answer 17

typical example is IDDM, but Hashimoto thyroiditis is also good example

Question 18

what is Hashimoto’s thyroiditis characterised by

Answer 18

characterised by destruction of thyroid cells by various cell and antibody mediated processes
- presence of typically anti-TPO (anti thyroid peroxidase) and anti-Tg (anti thyroglobulin) antibodies
- but 15% of patients with Hashimoto’s thyroiditis may be antibody negative

Question 19

outline the treatment of hashimotos thyroiditis

Answer 19

1. just like any other hypothyroid state
2. treatment choice is thyroid hormone replacement
3. drug of choice is individually tailored and titrated levothyroxine sodium administered orally, usually for life