Rheumatoid arthritis and osteoarthritis

Question 1

How is the rheumatoid arthritis (RA) diagnose established?

Answer 1

• Morning stiffness > 1 time*
• Arthritis in 3 or more joints areas*
• Arthritis involving the jount of the hands*
• Symmetrical arthritis*
• Rheumatic nodules
• Rheumatoic factor
• Erosions

4 ud af 7 skal være tilstede. *Present for more than 6 weeks

Question 2

DAS28

Answer 2

Disease activity score using 28 joints.

High disease activity DAS28 of > 5.1
Moderate: DAS28 of > 3.2 to 5.1
Low activity: 2.6-3.2
Remission: < 2.6

Question 3

Investigations

Answer 3

Inflammatory markers:
C-reactive protine
Erythrocyte sedimentation rate (ERS)

Question 4

Goals in treatment?

Answer 4

Symptom relief - pain control
Slowing or prevention of joint damage
Preserving and improving functional ability
Achieving and maintaining disease remission

Question 5

The four main categories of drugs

Answer 5

NSAIDs
Glucorticoids
DMARDS
Biologisk behandling

Question 6

NSAIDs

Answer 6

Reduce jount pain and swelling

SYMPTOMAIC RELIEF

Lowest effective dosis for the shortest possible period of time.

Use of PPI!

Avoid if possible.

Question 7

DMARDs

Hvilke bruges oftest, og har clear evidens of benefit?

Answer 7

Methotrexate (MTX)
Sulphasalazine
Leflunomide
Intramuscular Gold

Question 8

DMARDs som kombinationsterapi

Answer 8

First-line therapy: MTX + mindst en anden DMARD såsom sulphasalazine

Question 9

Hvordan virker de forskellige DMARDs?

Answer 9

Methotrexate: Folic acid antagonist
Salazopyrin: Sulfapyrin + Pentasa
Hydroxy-chloroquine: TLR-inhibition
Leflunomid: DHODH inhibitor

Question 10

Glucocorticoider

Answer 10

Anvendes i starten af behandling af arthritis, da DMARDs har slow onset.

Question 11

Biological treatment for rhematoid arthritis

Answer 11

Biologics are used after a patient has failed DMARDs.

• anti-TNF-alpha. (First line agent)
• Interleukines

Question 12

Interlekukins, mechanism

Answer 12

Anakinra which bloks the binding of interleukin-1 to its receptor. (weak evidens)

Rituximab: Human-murine monoclonal antibody.

Abtacept: Bloking the activation of T-cells

Tocilizumab: Binding to interleukin-6 receptors

Question 13

Risk factors in gout

Answer 13

Increasing age
Gender (male)
Obesity
Hypertension

Lifestyle: Meat and red wine.
Uric acid is the end product of Purine (aminoacid)

Question 14

Treatment of gout?

Answer 14

During attacs: NSAIDs, steorids, colchicine

Prophylaxis: Allopurin, colchicine

Question 15

What is osteoarthritis (OA)?

Risk factors?

Answer 15

”degenerative” loss of cartilage

Risk factors: Obestiy, increasing age, genetic predisposition

Question 16

Treatment of osteoarthritis (OA)?

Medical treatment and non-medical treatment?

Answer 16

• change of life-style -Weight loss & exercise!
• analgetics
• cirgury

Medical treatment: First line: Paracetamol

The exercise: If pain by running, alternatives: Swimming, bicycling.

Question 17

Symptoms and diagnosis of OA?

Answer 17

Clinical manifestations

Imaging

Question 18

Mechanism of action of colchicine

GOUT

Answer 18

Modulation of chemokine and prostanoid
production and inhibition of neutrophil and endothelial cell
adhesion molecules by which it interferes with the initiation
and amplification of the joint inflammation

Question 19

Interactions in treatment of GOUT?

Answer 19

NSAIDs counteract the effect of ACE-inhibitors. The effect of ACE-inhibitors is lowered.

–> Udskift ACE-hæmmer med evt. ANG II inhibitor.

Question 20

Diagnosis of OA?

Answer 20

Take a picture of the bone.

Question 21

Hvorfor kan en patient med gigt få anemia?

Answer 21

Ved gigt kan der dannes autoantistoffer mod kroppens med de røde blodlegemer, som herefter nedbrydes. Dette medfører at blodlegemerne nedbrydes hurtigere end normalt, hvorfor der opstår en normochromisk normocytisk anæmi, altså hvor blodlegemerne har normalt udseende og funktion, men blot nedbrydes hurtigere end den normale halveringstid på 120 dage.