Rheumatology joint disease profiles

Question 1

Describe the clinical presentation of rheumatoid arthritis identifying the differences from osteoarthritis

Answer 1

Symmetrical,
Peripheral joints,
Systemic involvement (lungs),
Prolonged morning stiffness,
Short presentation (months rather than years)

Both:
Pain, joint swelling, more common in women

Question 2

What is the pathogenesis of rheumatoid arthritis?

Answer 2

Genetically mediated autoimmune disease causing synovial membrane thickening and increased synovial fluid secretion
(thickening can progress to bone erosion and damage)

Question 3

What auto-antibody is most reliable is diagnosis of rheumatoid arthritis?

Answer 3

Anti-CCP antibodies (not rheumatoid factor)

Question 4

What is the progression of treatment of rheumatoid arthritis treated?

Answer 4

NSAIDs –> steroids (not long term) –> DMARDs –> biologics
(increase until remission achieved then gradually decrease)

Question 5

What does DMARDs stand for and give some examples?

Answer 5

Disease modifying anti rheumatic drugs

methotrexate

Question 6

Which joints are affected in osteoarthritis?

Answer 6

Weight bearing and well used joints (hands/neck/thumb)

Question 7

What is the pathophysiology of osteoarthritis?

Answer 7

Articular cartilage damaged causing loss of joint space, osteophytes can form (causing bony enlargement)

Question 8

What is the process of diagnosis of osteoarthritis?

Answer 8

X-ray (loss of joint space),
History,
Examination (tender and swollen joints)

Question 9

How is osteoarthritis treated?

Answer 9

Non-medical; physio and keep using joints
NSAIDs
Inter-articular steroid injections
DEFINITIVE: joint replacement (surgery)

Question 10

What causes gout?

Answer 10

Uric acid crystal deposition in joints (either from overproduction or under excretion leading to insoluble levels)

Question 11

What are the features of gout?

Answer 11

Swelling, tenderness, pain, redness in joints (particularly toe) - more common in men

Question 12

How is gout diagnosed?

Answer 12

Synovial fluid aspiration - needly shaped crystals under polarising light

Question 13

What is the treatment for gout?

Answer 13

NSAIDs –> colchicine –> steroids

Question 14

What are the 2 forms of pseudo-gout?

Answer 14

Calcium pyrophosphate or hydroxyapatite crystal deposition

Question 15

Where do the two forms of pseudo-gout mainly affect?

Answer 15

Calcium pyrophosphate: wrist and knee

Hydroxyapatite: shoulder

Question 16

How is pseudo-gout diagnosed?

Answer 16

Calcium pyrophosphate: joint aspirate and examination

Hydroxyapatite: X-ray changes (joint aspirate to rule out gout/calcium pyrophosphate)

Question 17

How is calcium pyrophosphate or hydroxyapatite pseudo gout treated?

Answer 17

Calcium pyrophosphate:
NSAIDs –> colchicine –> steroids

Hydroxyapatite:
NSAIDs –> inter-articular steroid injection –> physio

Question 18

What are the X-ray changes seen in osteoarthritis?

Answer 18

LOSS
L: loss of joint space
O: osteophyte formation
S: subchondral cyst formation
S: subchondral sclerosis