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What is a primary characteristic of primary osteoarthritis?
Which of the following is NOT considered a risk factor for developing osteoarthritis?
Which of the following factors is indicative of secondary osteoarthritis?
What type of osteoarthritis is characterized by the deposition of calcium pyrophosphate crystals?
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What is a possible outcome of osteoarthritis that primarily affects articular cartilage?
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What characteristic feature is most commonly associated with rheumatoid arthritis (RA)?
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Which of the following conditions is NOT associated with rheumatoid arthritis?
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What does a negative rheumatoid factor (RF) result indicate?
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Which hand deformity involves the PIP becoming stuck in a bent position, with the MCP and DIP hyperextending?
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Which of the following is a hematological manifestation of RA?
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What is a common symptom of osteoarthritis related to joint movement?
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Which of the following is NOT typically associated with osteoarthritis?
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What is the most characteristic bony feature seen in advanced osteoarthritis?
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How does pain in osteoarthritis typically present during weight-bearing activities?
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Which signs typically suggest the progression of osteoarthritis in weight-bearing joints?
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Which test is commonly used to evaluate for osteoarthritis diagnosis?
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What is the typical duration of morning stiffness experienced by most individuals with osteoarthritis?
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Which of the following statements regarding muscle involvement in osteoarthritis is accurate?
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What is a critical management approach for individuals with osteoarthritis?
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Which radiological finding is a hallmark of osteoarthritis?
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What is the specificity of anti-citrullinated protein antibodies (ACPA) when positive?
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Which of the following criteria must be met to diagnose rheumatoid arthritis?
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What is the management goal for rheumatoid arthritis treatment?
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Which of the following is NOT a complication associated with rheumatoid arthritis?
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Which type of juvenile idiopathic arthritis (JIA) does NOT involve many joints?
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What initial symptom might indicate juvenile rheumatoid arthritis?
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What level of rheumatoid factor is indicative of the disease?
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Which of the following is a goal of management in juvenile idiopathic arthritis?
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Which type of drug is commonly used in the management of rheumatoid arthritis?
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What is the typical age range for the peak incidence of juvenile idiopathic arthritis?
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What is a characteristic feature of ankylosing spondylitis?
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Which demographic is most commonly affected by ankylosing spondylitis?
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What role does the HLA B27 gene play in ankylosing spondylitis?
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What is the primary category of medications used to manage ankylosing spondylitis?
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Which of the following is true regarding septic arthritis, particularly in the context of HIV?
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What is a notable effect of hyperuricemia in HIV patients?
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What type of arthritis is often seen more frequently in HIV-positive patients who are HLA-B27 positive?
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What is the estimated percentage of HIV patients that may experience HIV-associated polymyositis?
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Study Notes
Osteoarthritis (OA)
- Primarily affects articular cartilage, a degenerative condition.
- Affects bone, synovial membrane, capsule, ligaments, and muscles.
- Localized pain worsens with activity and relieves with rest. Do
- Weight-bearing joints may lock or give way in advanced cases.
- Morning stiffness typically lasts less than 30 minutes.
Classification of OA
- Primary OA: More common, cause unknown, often in the elderly, wear and tear
- Secondary OA: Due to injury, infection, RA, obesity, deformity, hyperthyroidism.
Types of OA
- Nodal Generalized OA
- Crystal Associated OA: Mainly in elderly, women, often in the knee. Calcium pyrophosphate crystal deposition (CPPD) makes it worse, more painful, and stiffer.
- OA of Premature Onset: Previous meniscectomy or hemochromatosis.
Clinical Features of OA
- Pain:
- Worsens with activity, relieved by rest (initially), may disturb sleep later, may be diffuse or sharp.
- Possible causes: raised intra-osseous pressure, inflammatory synovitis, periosteal elevation, muscular changes, fibromyalgia, central neurogenic changes.
- Stiffness
- Muscle spasm
- Restricted movement
- Deformity
- Muscle weakness or wasting
- Joint enlargement and instability
- Crepitus
- Joint effusion
Signs of OA
- Bony enlargement
- Crepitus
- Cool effusions
- Decreased range of motion
- Tenderness on palpation at the joint line
- Pain on passive motion
- No boggy synovitis (unlike inflammatory arthritis).
Diagnosis of OA
- History and Physical Examination
- Laboratory Tests: ESR, RF, synovial fluid analysis.
- Radiographic Study: X-rays or MRI.
Radiological Features of OA
- Osteophyte formation (most specific in advanced disease)
- Joint space narrowing
- Subchondral sclerosis (bony sclerosis at areas of cartilage loss)
- Cysts
- Bouchard’s nodes (proximal interphalangeal joints)
- Heberden’s nodes (distal interphalangeal joints)
Management of OA
- Education
- Relieve symptoms, control pain and swelling
- Minimize handicap
- Limit progression, prevent disabilities
- Weight loss
Rheumatoid Arthritis (RA)
- Chronic, inflammatory disease affecting the joints.
- Often symmetrical but can initially be asymmetrical.
Clinical Features of RA
- Pain
- Stiffness
- Muscle spasm
- Restricted movement
- Deformity
- Muscle weakness or wasting
- Joint enlargement and instability
- Crepitus
- Joint effusion
Hand Deformities in RA
- Trigger fingers
- Boutonniere deformity (middle PIP bent, MCP and DIP hyperextend)
- Swan neck deformity (MCP and DIP flex, PIP hyperextends)
- Hitchhiker’s thumb (MCP flexes, IP hyperextends)
- Ulnar deviation (MCP dislocates towards ulnar side).
Rheumatoid Nodules
- Often subcutaneous, characteristic feature of RA.
Non-Articular Manifestations of RA
- Systemic: fever, weight loss, fatigue
- Eyes: Scleritis, perforation of the eye.
- Neurological: Carpal tunnel syndrome, atlanto subluxation, cord compression.
- Hematological: Lymphadenopathy, Felty’s syndrome (RA, splenomegaly, neutropenia), Anemia.
- Pulmonary: Pleural effusions, lung fibrosis, Rheumatoid nodules.
- Heart and Peripheral Vessels: Pericarditis, pericardial effusions, Raynaud’s syndrome.
- Vasculitis: Leg ulcers, gangrene of fingers and toes.
- Kidneys: Amyloidosis, nephrotic syndrome, renal failure.
Blood Tests for RA
- Raised ESR and CRP
- Anemia
- Rheumatoid Factor (RF): Specific antibody in the blood. A negative RF does not rule out RA (seronegative RA).
- Anti-citrullinated protein antibodies (ACPA’s): Positive in some cases. Highly specific if positive (95%).
X-rays for RA
- Joint narrowing
- Erosions at the joint margins
Diagnosis of RA
-
Diagnostic Criteria:
- Morning Stiffness > 1 hour for 6 weeks.
- Arthritis and soft tissue swelling in > 3 of 14 joints for 6 weeks.
- Arthritis of the hand joints for 6 weeks.
- Symmetrical arthritis for 6 weeks.
- Subcutaneous nodules in specific places.
- Rheumatoid factor above the 95 percentile.
- Radiological changes suggestive of joint erosion.
Synovial Fluid in RA
- High neutrophil count in uncomplicated disease.
Complications of RA
- Ruptured tendons
- Ruptured joints (baker's cysts)
- Joint infections
- Spinal cord compressions
- Side effects of therapy
Management of RA
-
Goals:
- Remission
- Full functional return
- Maintenance of remission with disease modifying agents.
-
Multidisciplinary approach:
- Drug therapy: Cortisone, anti-inflammatory agents, drugs affecting the immune system.
- Other therapies: Weight loss, OT, podiatry, physiotherapy, acupuncture.
Juvenile Rheumatoid Arthritis (JIA)
- Form of arthritis affecting children under 16.
- Symptoms for at least 6 weeks.
- Onset type observed after 6 months.
-
Types:
- Pauciarticular
- Polyarticular
- Systemic
Epidemiology of JIA
- Rare before 6 months.
- Peak age 1-3 years.
- New cases throughout childhood.
Signs and Symptoms of JIA
- Inflammation of synovium
- Morning stiffness (may present as increased irritability, guarding, or refusal to walk)
- Fatigue
- Low-grade fever
- Anorexia
- Weight loss
- Failure to grow
- Serositis
- Red eyes
Diagnosis of JIA
- History and examination
- Blood tests (e.g., Rheumatoid Factor)
- X-rays and MRI
Management of JIA
- Drug therapy: NSAIDs, Immune Modulatory and Biologics (watch for infections, side effects, avoid live vaccines).
- Supportive care: OT, Physio, schools, ophthalmology.
- Goals: Remission, minimal medication toxicity, maximum function, optimized growth and development, improved quality of life.
Ankylosing Spondylitis (AS)
- Chronic form of arthritis primarily affecting the spine.
- Affects joints in the spine and sacroilium, causing eventual fusion of the spine.
- Complete fusion results in rigidity of the spine (bamboo spine).
- Systemic rheumatic disease, one of the negative spondyloarthropathies.
Epidemiology of AS
- Typically young men (18-30 years).
- Male to female ratio 3:1
- Cause unknown, but genetic factors play a role (HLA-B27 gene).
X-rays for AS
- Characteristic spinal changes and sacroiliitis
Management of AS
- No cure
- General treatment:
- Drug therapy:
- Anti-inflammatory drugs
- DMARDs (disease modifying anti-rheumatic drugs)
- TNF alpha blockers (antagonists) (biologics)
- Drug therapy:
- Surgery (osteotomy, arthroplasty)
Rheumatologic Conditions in HIV
- HIV-associated arthritis: Nonerosive oligoarthritis, mainly affects legs, unknown cause, self-limiting, lasts less than 6 weeks.
- Reiter’s syndrome (reactive arthritis): More common in HIV-positive patients with HLA-B27, treated with HIV suppression and TNF-alpha antagonists.
- Septic arthritis: Mainly sternoclavicular and leg joints.
- Gout: Hyperuricemia common with HIV, often from drugs.
- Rhabdomyolysis: In primary HIV infection or complicates statin use in HAART.
- HIV-associated polymyositis: 2-7% of patients with HIV.
- Other: Vasculitis, SLE, sarcoidosis, drug-related.
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Description
This quiz delves into osteoarthritis (OA), focusing on its effects on articular cartilage and related structures. Explore the various classifications of OA, including primary and secondary types, as well as their clinical features. Test your knowledge of OA's specific characteristics and implications.
