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Sem 2 LEAPS > Week 1 - OA, RA and RCT/Therapy questions > Flashcards

Week 1 - OA, RA and RCT/Therapy questions Flashcards

1
Q

What proportion of those with arthritis also have a musculoskeletal condition?

A

1/4 - over 1.5 million

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2
Q

What proportion of those with arthritis have had at least one mental disorder in the last 12 months?

A

1/4 - over 1.5 million

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3
Q

Describe the main differences between OA and RA

A

See RA in younger patients
See RA to a greater degree in female patients
RA is inflammatory - see more systemic symptoms
RA has a more acute onset

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4
Q

What are some RA risk factors?

A

Genetics (~50%)
Smoking
Some environmental RF
Female - 5/8

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5
Q

What are symptoms of RA?

A 
Joint pain and stiffness that is symmetrical and more prominent in the morning - lasts at least 30 minutes
Red, warm and swollen joints
Joint deformities
Slight fever
Limited movement
Fatigue
Loss of appetite
Small lumps/nodules
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6
Q

Where are the three main sites of RA complications?

A

Eyes
Skin
Nervous System

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7
Q

Which disease is RA linked to?

A

Early cardiovascular disease

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8
Q

Which are the main joints affected by RA?

A 
Metacarpophalangeal joints
Proximal interphalangeal joints
Wrist joints
Metatarsophalangeal joints
--> most joints of the body can be affected
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9
Q

Where on the hands to nodes in RA develop?

A

Distal interphalangeal joint
Proximal interphalangeal joint
Metacarpophalangeal joint

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10
Q

Which tests would you request when investigating RA?

A

Rheumatoid factor and anti-cyclic citrullinated peptide antibody –> these are not diagnostic but can reflect severity of disease
Also ESR and CRP tests can be useful, as RA is inflammatory
Microbiological test could be used to rule out infection

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11
Q

Describe the disease course of RA

A

Immune response initiates
Subclinical inflammation
Symptoms - joint inflammation & pathological/inflam responses
Joint destruction
Infections, lymphomas, osteoporosis & cardiovascular complications can occur

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12
Q

What is a pannus and which stage of RA does it reflect?

A

Pannus is an abnormal layer of fibrovascular tissue. In RA, is an inflamed synovium, responsible for invasion and eventual destruction of cartilage and bone
Found in second stage of RA

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13
Q

what is the first symptom of RA?

A

Synovitis - inflammation of the synovial membrane that lines the synovial joint

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14
Q

What is stage four of RA?

A

Fibrous ankylosis - breakdown of bone resulting in a fibrous connective tissue, causing complete joint immobility

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15
Q

What is stage five of RA?

A

Bony ankylosis- no pain and swelling anymore, bone of the joint has collapsed, forming a single unit of the two bones - makes extension impossible

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16
Q

What is the cut point for RA on the European League against Rheumatism 2010 criteria?

A

6 or more

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17
Q

Where is the most money spent on in OA?

A

Pharmaceuticals (~77%), $335 million

18
Q

Why is it important to start treatment ASAP for OA?

A

Aggressive treatment early in the disease can alter it’s course, preventing or delaying joint damage decreasing chance of disease remission, and improving long term outcomes

19
Q

What is the median time between OA symptoms and start of treatment?

A

173 days

20
Q

What are some pharmaceutical drugs used for RA

A

Paracetemol, coedine, non-steroidal anti-inflams, corticosteroids
Disease modifying anti-rheumatic drugs (DMARDs)
Analgesics

21
Q

What are some dietary supplements used for RA?

A

Fish oil (Omega-3), antioxidants

22
Q

What are some ‘physical’ treatments used in management of RA?

A

Physical activity/therapy - aerobic, high vs low intensity, hydrotherapy, tai chi, massage
Joint protection/splints for wrists and feet
Surgery

23
Q

How many times more likely are you to report:
high levels of psyc distress
Severe/very severe pain
With RA?

A
  1. 7x more likely to have psyc distress

3. 3x more likely to have severe/very severe pain

24
Q

Which age groups are more likely to have psyc disorders with RA?

A

45-54 is highest

35-44 and 55-64 are also high

25
Q

When do you become limited by RA for things like work?

A

Immediately - acute onset of symptoms

26
Q

Outline determinants/risk factors of OA

A

Genetics, female, over 45 are risk factors

Biomechanical risk factors - obesity, misalignment, joint trauma/injury, repetitive joint use, physical inactivity

27
Q

Describe clinical features of OA

A

Transient stiffness in morning and after resting
Joint pain with activity
Reduced range of motion

28
Q

What are signs/symptoms of OA?

A

Pain on range of motion, limitation on range of motion, crepitus, joint effusion (esp knee), lateral knee instability, stiffness under 30 minutes

29
Q

When do osteophytes develop in OA?

A

In moderate/severe disease

30
Q

What are some microscopic changes of OA?

A

vascular infiltration, osteophyte formation, osteoclasts, activated macrophages in synovium, thickened and fibrotic synovium, fissure lesions in bone, apoptopic chondrocytes, cartilage erosion, pores in the subchondral bone plate

31
Q

Is arthroscopy an option for OA patients?

A

No - don’t offer it

32
Q

What is Australia’s expenditure on RA, and in which area is the most spent?

A

$1.6 billion, most spent admitted patients, not pharmaceuticals like OA

33
Q

Which joints are most commonly affected by OA?

A

Distal interphalangeal joints, spine, knee, hip, hand and foot joints

34
Q

What are some pharmaceutical treatments of OA?

A

Analgesics like panadol, NSAIDs and capsaicin
Corticosteroid injections
Platelet-rich plasma injections
Hyaluronic acid

35
Q

What are some complementary treatments for OA?

A

Dietary supplements like glucosamine hydrochloride and glucosamine sulfate, chondroitin sulfate, zingiber officinale

36
Q

What are some non-pharmalogical treatments for OA?

A

Exercise/physiotherapy/Tai Chi
Balneotherapy & acupuncture
Laser therapy
Ultrasound

37
Q

How many times more likely are you to report psyc distress, and severe/very severe pain with OA?

A
  1. 5 x more likely for psyc

2. 8x more likely for pain

38
Q

How many people have OA in Australia, and what % are female?

A

1/13 people have OA

~66% are female

39
Q

How does perception of health change when you have OA?

A

24% report fair/poor health, while 13% of those without OA report fair/poor health

40
Q

How can you differentiate between OA and RA, based on when pain occurs?

A

Both have pain in the morning, but because RA is inflammatory, usually get more pain when resting, compared to OA, where there’s more pain when moving

Sem 2 LEAPS (2 decks)

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