Osteoarthritis Overview and Classification

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Questions and Answers

What is a primary characteristic of primary osteoarthritis?

It occurs mainly in younger demographics.

It is less common than secondary osteoarthritis.

It is often associated with aging and is more common in the elderly. (correct)

It has a known cause related to injuries.

Which of the following is NOT considered a risk factor for developing osteoarthritis?

Obesity

Incompletely treated congenital dislocation of the hips

Aging process in joint cartilage

Regular exercise (correct)

Which of the following factors is indicative of secondary osteoarthritis?

Injury or previous infections (correct)

Wear and tear with age

Aging process in joint cartilage

Defective lubricating mechanisms

What type of osteoarthritis is characterized by the deposition of calcium pyrophosphate crystals?

Crystal associated osteoarthritis Signup and view all the answers

What is a possible outcome of osteoarthritis that primarily affects articular cartilage?

Increased pain and stiffness Signup and view all the answers

What characteristic feature is most commonly associated with rheumatoid arthritis (RA)?

Ulnar deviation of the MCP joints Signup and view all the answers

Which of the following conditions is NOT associated with rheumatoid arthritis?

Osteoporosis and bone fractures Signup and view all the answers

What does a negative rheumatoid factor (RF) result indicate?

The patient has seronegative RA Signup and view all the answers

Which hand deformity involves the PIP becoming stuck in a bent position, with the MCP and DIP hyperextending?

Boutonniere deformity Signup and view all the answers

Which of the following is a hematological manifestation of RA?

Splenomegaly Signup and view all the answers

What is a common symptom of osteoarthritis related to joint movement?

Localized joint pain that worsens with activity Signup and view all the answers

Which of the following is NOT typically associated with osteoarthritis?

Boggy synovitis Signup and view all the answers

What is the most characteristic bony feature seen in advanced osteoarthritis?

Osteophyte formation Signup and view all the answers

How does pain in osteoarthritis typically present during weight-bearing activities?

Aggravated by stress on the synovial membrane Signup and view all the answers

Which signs typically suggest the progression of osteoarthritis in weight-bearing joints?

Decreased range of motion Signup and view all the answers

Which test is commonly used to evaluate for osteoarthritis diagnosis?

Joint aspiration for fluid analysis Signup and view all the answers

What is the typical duration of morning stiffness experienced by most individuals with osteoarthritis?

Less than 15 minutes Signup and view all the answers

Which of the following statements regarding muscle involvement in osteoarthritis is accurate?

Muscle weakness may occur due to joint discomfort Signup and view all the answers

What is a critical management approach for individuals with osteoarthritis?

Educate on obesity and its impact on joints Signup and view all the answers

Which radiological finding is a hallmark of osteoarthritis?

Narrowed joint space Signup and view all the answers

What is the specificity of anti-citrullinated protein antibodies (ACPA) when positive?

95% Signup and view all the answers

Which of the following criteria must be met to diagnose rheumatoid arthritis?

Symmetric arthritis for more than 6 weeks Signup and view all the answers

What is the management goal for rheumatoid arthritis treatment?

Alleviation of current symptoms and prevention of joint destruction Signup and view all the answers

Which of the following is NOT a complication associated with rheumatoid arthritis?

Tumors at the joint Signup and view all the answers

Which type of juvenile idiopathic arthritis (JIA) does NOT involve many joints?

Pauciarticular Signup and view all the answers

What initial symptom might indicate juvenile rheumatoid arthritis?

Increased irritability Signup and view all the answers

What level of rheumatoid factor is indicative of the disease?

Above the 95th percentile Signup and view all the answers

Which of the following is a goal of management in juvenile idiopathic arthritis?

Maximize function and minimize medication toxicity Signup and view all the answers

Which type of drug is commonly used in the management of rheumatoid arthritis?

Cortisone Signup and view all the answers

What is the typical age range for the peak incidence of juvenile idiopathic arthritis?

1 to 3 years Signup and view all the answers

What is a characteristic feature of ankylosing spondylitis?

Complete fusion leading to a rigid spine Signup and view all the answers

Which demographic is most commonly affected by ankylosing spondylitis?

Young men aged 18-30 Signup and view all the answers

What role does the HLA B27 gene play in ankylosing spondylitis?

It is a marker indicating a higher risk Signup and view all the answers

What is the primary category of medications used to manage ankylosing spondylitis?

Drug therapy including anti-inflammatory and DMARDs Signup and view all the answers

Which of the following is true regarding septic arthritis, particularly in the context of HIV?

It primarily affects the sternoclavicular and leg joints Signup and view all the answers

What is a notable effect of hyperuricemia in HIV patients?

Common occurrence of gout Signup and view all the answers

What type of arthritis is often seen more frequently in HIV-positive patients who are HLA-B27 positive?

Reiter’s syndrome Signup and view all the answers

What is the estimated percentage of HIV patients that may experience HIV-associated polymyositis?

2-7% Signup and view all the answers

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)
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.