Week 1 - OA, RA and RCT/Therapy questions Flashcards
What proportion of those with arthritis also have a musculoskeletal condition?
1/4 - over 1.5 million
What proportion of those with arthritis have had at least one mental disorder in the last 12 months?
1/4 - over 1.5 million
Describe the main differences between OA and RA
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
What are some RA risk factors?
Genetics (~50%)
Smoking
Some environmental RF
Female - 5/8
What are symptoms of RA?
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
Where are the three main sites of RA complications?
Eyes
Skin
Nervous System
Which disease is RA linked to?
Early cardiovascular disease
Which are the main joints affected by RA?
Metacarpophalangeal joints Proximal interphalangeal joints Wrist joints Metatarsophalangeal joints --> most joints of the body can be affected
Where on the hands to nodes in RA develop?
Distal interphalangeal joint
Proximal interphalangeal joint
Metacarpophalangeal joint
Which tests would you request when investigating RA?
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
Describe the disease course of RA
Immune response initiates
Subclinical inflammation
Symptoms - joint inflammation & pathological/inflam responses
Joint destruction
Infections, lymphomas, osteoporosis & cardiovascular complications can occur
What is a pannus and which stage of RA does it reflect?
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
what is the first symptom of RA?
Synovitis - inflammation of the synovial membrane that lines the synovial joint
What is stage four of RA?
Fibrous ankylosis - breakdown of bone resulting in a fibrous connective tissue, causing complete joint immobility
What is stage five of RA?
Bony ankylosis- no pain and swelling anymore, bone of the joint has collapsed, forming a single unit of the two bones - makes extension impossible
What is the cut point for RA on the European League against Rheumatism 2010 criteria?
6 or more
Where is the most money spent on in OA?
Pharmaceuticals (~77%), $335 million
Why is it important to start treatment ASAP for OA?
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
What is the median time between OA symptoms and start of treatment?
173 days
What are some pharmaceutical drugs used for RA
Paracetemol, coedine, non-steroidal anti-inflams, corticosteroids
Disease modifying anti-rheumatic drugs (DMARDs)
Analgesics
What are some dietary supplements used for RA?
Fish oil (Omega-3), antioxidants
What are some ‘physical’ treatments used in management of RA?
Physical activity/therapy - aerobic, high vs low intensity, hydrotherapy, tai chi, massage
Joint protection/splints for wrists and feet
Surgery
How many times more likely are you to report:
high levels of psyc distress
Severe/very severe pain
With RA?
- 7x more likely to have psyc distress
3. 3x more likely to have severe/very severe pain
Which age groups are more likely to have psyc disorders with RA?
45-54 is highest
35-44 and 55-64 are also high
