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
When do you become limited by RA for things like work?
Immediately - acute onset of symptoms
Outline determinants/risk factors of OA
Genetics, female, over 45 are risk factors
Biomechanical risk factors - obesity, misalignment, joint trauma/injury, repetitive joint use, physical inactivity
Describe clinical features of OA
Transient stiffness in morning and after resting
Joint pain with activity
Reduced range of motion
What are signs/symptoms of OA?
Pain on range of motion, limitation on range of motion, crepitus, joint effusion (esp knee), lateral knee instability, stiffness under 30 minutes
When do osteophytes develop in OA?
In moderate/severe disease
What are some microscopic changes of OA?
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
Is arthroscopy an option for OA patients?
No - don’t offer it
What is Australia’s expenditure on RA, and in which area is the most spent?
$1.6 billion, most spent admitted patients, not pharmaceuticals like OA
Which joints are most commonly affected by OA?
Distal interphalangeal joints, spine, knee, hip, hand and foot joints
What are some pharmaceutical treatments of OA?
Analgesics like panadol, NSAIDs and capsaicin
Corticosteroid injections
Platelet-rich plasma injections
Hyaluronic acid
What are some complementary treatments for OA?
Dietary supplements like glucosamine hydrochloride and glucosamine sulfate, chondroitin sulfate, zingiber officinale
What are some non-pharmalogical treatments for OA?
Exercise/physiotherapy/Tai Chi
Balneotherapy & acupuncture
Laser therapy
Ultrasound
How many times more likely are you to report psyc distress, and severe/very severe pain with OA?
- 5 x more likely for psyc
2. 8x more likely for pain
How many people have OA in Australia, and what % are female?
1/13 people have OA
~66% are female
How does perception of health change when you have OA?
24% report fair/poor health, while 13% of those without OA report fair/poor health
How can you differentiate between OA and RA, based on when pain occurs?
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
