NUR 425 WEEK 10
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Questions and Answers

What differentiates the onset of rheumatoid arthritis (RA) from osteoarthritis (OA)?

  • RA primarily affects older adults.
  • RA can develop and worsen over weeks or months. (correct)
  • RA develops gradually over years.
  • RA is characterized by asymmetrical joint involvement.

Which of the following is considered a Conventional Disease-Modifying Anti-Rheumatic Drug (DMARD)?

  • Methotrexate (correct)
  • Corticosteroids
  • Ibuprofen
  • Acetaminophen

What symptom is specifically associated with rheumatoid arthritis (RA) and not osteoarthritis (OA)? (SATA)

  • Anorexia (correct)
  • Inflammation (correct)
  • Joint pain
  • Morning stiffness lasting more than 30 minutes (correct)

Which of the following laboratory tests has shown to be a specific marker for rheumatoid arthritis (RA) in 80% of cases?

<p>Rheumatoid factor (RF) (D)</p> Signup and view all the answers

What is the primary joint involvement pattern seen in rheumatoid arthritis (RA)?

<p>Symmetrical joint involvement (D)</p> Signup and view all the answers

Which of the following treatments provides rapid relief in rheumatoid arthritis but is recommended for short-term use only?

<p>Corticosteroids (D)</p> Signup and view all the answers

What is a common feature observed in synovial fluid analysis for rheumatoid arthritis compared to osteoarthritis?

<p>Presence of inflammatory cells (B)</p> Signup and view all the answers

Which pain management strategy is recommended for patients with rheumatoid arthritis?

<p>Rest and exercise balance (A)</p> Signup and view all the answers

What is a characteristic pathophysiological change in rheumatoid arthritis?

<p>Inflamed synovium (D)</p> Signup and view all the answers

Which side effect is commonly associated with methotrexate treatment in rheumatoid arthritis?

<p>Skin reactions (B)</p> Signup and view all the answers

What is a key radiological sign indicative of osteoarthritis?

<p>Subchondral sclerosis (D)</p> Signup and view all the answers

Which symptom is commonly associated with rheumatoid arthritis?

<p>Systemic fatigue and fever (C)</p> Signup and view all the answers

What nonpharmacologic intervention can help manage symptoms of osteoarthritis?

<p>Acupuncture (A)</p> Signup and view all the answers

In terms of cyclooxygenase inhibitors, what are the significant risks associated with COX-2 inhibitors? (SATA)

<p>Renal impairment (D), Increased risk for myocardial infarction (A)</p> Signup and view all the answers

Which of the following statements accurately reflects the characteristics of COX-1?

<p>Protects gastric mucosa (D)</p> Signup and view all the answers

What is a common clinical manifestation of osteoarthritis?

<p>Joint stiffness and crepitation (B)</p> Signup and view all the answers

Which of the following medications is indicated for mild to moderate pain in osteoarthritis?

<p>Acetaminophen (B)</p> Signup and view all the answers

What type of fluid analysis is typically not necessary for diagnosing osteoarthritis?

<p>Synovial fluid analysis (D)</p> Signup and view all the answers

What is the primary function of cartilage in a synovial joint?

<p>To cushion the joint (C)</p> Signup and view all the answers

Which risk factor is most directly linked to the development of osteoarthritis?

<p>Increasing age (B)</p> Signup and view all the answers

What clinical manifestation is commonly associated with osteoarthritis in the morning?

<p>Stiffness that resolves within 30 minutes (D)</p> Signup and view all the answers

Which of the following statements about Heberden's and Bouchard's nodes is correct?

<p>Both types of nodes result from cartilage degradation. (A)</p> Signup and view all the answers

What change typically occurs to synovial fluid in patients with osteoarthritis?

<p>Decrease in quantity and change in composition (D)</p> Signup and view all the answers

What is a common treatment option for managing pain associated with osteoarthritis?

<p>Pain management strategies, including medication (A)</p> Signup and view all the answers

Which structure of a synovial joint is primarily responsible for providing stability?

<p>Joint capsule (D)</p> Signup and view all the answers

What is primarily triggered by the presence of an antigen in rheumatoid arthritis?

<p>Formation of abnormal IgG (A)</p> Signup and view all the answers

What type of immune response occurs due to the infiltration of lymphocytes in the joint space during rheumatoid arthritis?

<p>Autoimmune response (D)</p> Signup and view all the answers

In later stages of osteoarthritis, which of the following typically occurs?

<p>Formation of osteophytes due to mechanical stress (A)</p> Signup and view all the answers

What type of cartilage degradation occurs with osteoarthritis?

<p>Articular cartilage becomes yellow, dull, and granular (D)</p> Signup and view all the answers

Which factor contributes to cartilage degradation in osteoarthritis?

<p>Increased biomechanical loads and joint overuse (B)</p> Signup and view all the answers

Which of the following is NOT a common early clinical manifestation of rheumatoid arthritis?

<p>Severe joint deformity (D)</p> Signup and view all the answers

What inflammatory effect does the accumulation of pannus have on the joints in rheumatoid arthritis?

<p>Destroys cartilage (C)</p> Signup and view all the answers

Which autoantibody is associated with rheumatoid arthritis and contributes to the immune complex formation?

<p>Rheumatoid factor (RF) (D)</p> Signup and view all the answers

What does the term ulnar drift refer to in the context of rheumatoid arthritis?

<p>Deviation of fingers towards the ulnar side (C)</p> Signup and view all the answers

Which of the following describes a common anatomical change observed in the severe stage of rheumatoid arthritis?

<p>Erosion of bone edges (B)</p> Signup and view all the answers

Which of the following describes the primary purpose of evaluating a patient for rheumatoid arthritis?

<p>To assess joint function over time (A)</p> Signup and view all the answers

What is the primary reason for the increased bone density observed in patients with osteoarthritis?

<p>Bone remodeling due to cartilage degradation (C)</p> Signup and view all the answers

What degenerative change is commonly observed in the late stages of osteoarthritis?

<p>Bone grinding against bone due to cartilage loss (C)</p> Signup and view all the answers

Which joint is most commonly affected by osteoarthritis due to its role in weight-bearing?

<p>Knee joint (C)</p> Signup and view all the answers

What is a notable histological feature of cartilage affected by osteoarthritis?

<p>Loss of the smooth, white appearance (C)</p> Signup and view all the answers

What is the role of autoantibodies in rheumatoid arthritis?

<p>They bind to abnormal IgG to create immune complexes. (B)</p> Signup and view all the answers

Which stage of rheumatoid arthritis is characterized by significant cartilage destruction and joint deformity?

<p>Severe stage (D)</p> Signup and view all the answers

What typically triggers the inflammatory response seen in rheumatoid arthritis?

<p>Presence of antigens leading to abnormal IgG (B)</p> Signup and view all the answers

What clinical manifestation is commonly observed in the moderate stage of rheumatoid arthritis?

<p>Development of granulation tissue (D)</p> Signup and view all the answers

Which of the following is a characteristic feature of rheumatoid arthritis deformities?

<p>Symmetrical joint involvement (B)</p> Signup and view all the answers

What is a common outcome when the inflammatory process in rheumatoid arthritis perpetuates over time?

<p>Bone degradation and loss of range of motion (A)</p> Signup and view all the answers

What is the primary joint manifestation of rheumatoid arthritis during its early stage?

<p>Thickened synovium and inflammatory response (D)</p> Signup and view all the answers

What is a common finding during a physical examination of a patient with osteoarthritis?

<p>Joint stiffness and crepitation on movement (B)</p> Signup and view all the answers

What is a critical adverse effect of COX-1 inhibition?

<p>Gastric erosion and ulceration (D)</p> Signup and view all the answers

Which type of cyclooxygenase is primarily associated with mediating inflammation at injury sites?

<p>COX-2 (B)</p> Signup and view all the answers

What is a primary risk factor for gastrointestinal side effects when using NSAIDs?

<p>History of an NSAID-induced ulcer (C)</p> Signup and view all the answers

What non-pharmacological strategy is recommended for managing osteoarthritis?

<p>Use of heat and cold therapy (C)</p> Signup and view all the answers

Which instruction is crucial to provide to a patient prescribed an NSAID for pain management?

<p>Monitor for signs of gastrointestinal bleeding (C)</p> Signup and view all the answers

What mechanism leads to increased joint pain during activity in osteoarthritis?

<p>Cartilage degradation and joint instability (B)</p> Signup and view all the answers

What anatomical location do distal interphalangeal joints refer to?

<p>Joints at the tips of the fingers (A)</p> Signup and view all the answers

Which of the following statements correctly describes the function of articular cartilage?

<p>Articular cartilage provides a smooth surface for joint movement and absorbs shock (B)</p> Signup and view all the answers

A patient with osteoarthritis asks the nurse about the primary goal of treatment. Which of the following is the most appropriate response?

<p>&quot;To reduce pain and improve joint function&quot; (C)</p> Signup and view all the answers

Which of the following is a common clinical manifestation of osteoarthritis?

<p>Joint pain that worsens with activity (C)</p> Signup and view all the answers

A patient with RA is prescribed a biologic response modifier. Which of the following is a common side effect of this class of medication?

<p>Increased risk of infection (A)</p> Signup and view all the answers

What are the risk factors of Osteroarthritis? (SATA)

<p>Increased age (A), Obesity (B), Traumatic injury or overuse of joints (C)</p> Signup and view all the answers

Flashcards

Osteoarthritis (OA)

A progressive joint disease causing cartilage deterioration and pain.

Risk factors for OA

Factors increasing likelihood of developing osteoarthritis, e.g., age, obesity, injuries.

Synovial Joint

A type of joint with cartilage, synovial fluid, and membranes to cushion and lubricate the joint.

Cartilage in OA

Degenerates in osteoarthritis, becoming rough & less smooth, leading to pain and reduced joint movement.

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Chondrocytes

Cells that create cartilage.

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Clinical Manifestations of OA

Symptoms of osteoarthritis including pain, stiffness, and crepitus.

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Heberden's node

A bony growth on the distal joints of the fingers, often resulting from OA.

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Bouchard's node

A bony growth on the proximal finger joints, often occurring in OA.

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Bone remodeling in OA

Changes in bone density and structure due to osteoarthritis, leading to less shock absorption and pain.

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OA Joint Symptoms

Pain, stiffness, reduced movement, and sometimes creaking sounds in affected joints.

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Rheumatoid arthritis (RA) pathogenesis

An autoimmune disease where the body's immune system attacks its own tissues, specifically the joints, causing inflammation and destruction.

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Antigen triggers RA

Antigen presence initiates the formation of abnormal IgG, a key component in RA development.

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Autoantibodies in RA

The body produces antibodies (e.g., rheumatoid factor (RF), anticitrullinated protein antibody (ACPA)) against the abnormal IgG.

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Immune complexes formation

The abnormal IgG and autoantibodies form complexes, often in the synovial membrane of joints, triggering inflammation.

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Synovial membrane inflammation

Inflammation of the synovial membrane, the lining of the joint, leads to pannus formation and joint damage.

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Pannus formation

Inflamed synovial tissue forms a destructive tissue (pannus) that erodes cartilage and bone in the joints.

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Early stage RA

Characterized by thickened synovium, inflammation, and lymphocyte infiltration into joints, leading to pannus formation in later stages.

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Moderate stage RA

Shows more inflamed and thickened joint lining, accumulation of fibrin, and development of granulation tissue; pannus destroying cartilage and bone.

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Severe stage RA

Severe RA results in significant joint impairment, bone erosion, and loss of joint stability; leading to noticeable deformities.

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RA clinical manifestations

RA symptoms include joint pain, stiffness (longer-lasting than osteoarthritis), loss of motion, low-grade fever, and potential deformities.

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Rheumatoid Factor (RF)

An antibody found in the blood of people with rheumatoid arthritis (RA), indicating the body's immune system is attacking its own tissues.

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Erythrocyte Sedimentation Rate (ESR)

A test that measures how quickly red blood cells settle to the bottom of a test tube. It's a non-specific indicator of inflammation.

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C-Reactive Protein (CRP)

A protein produced by the liver in response to inflammation. It's a non-specific indicator of inflammation.

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Anti-Cyclic Citrullinated Peptide Antibodies (ACPA)

Antibodies that target altered proteins in the joints, often found in people with rheumatoid arthritis.

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Synovial Fluid Analysis

Examining the fluid within a joint to identify inflammatory cells and crystals, providing a specific diagnosis.

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DMARDs

Disease-Modifying Anti-Rheumatic Drugs. Medications used to suppress the immune system in RA, aiming to slow down joint damage.

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Methotrexate

A conventional DMARD, often the first prescribed, that suppresses the immune system.

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Biologic DMARDs

A class of DMARDs that specifically target certain molecules involved in the immune response, aiming to reduce inflammation.

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NSAIDs for RA

Non-Steroidal Anti-Inflammatory Drugs, used to reduce pain and inflammation.

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Corticosteroids for RA

Strong medications used to quickly reduce inflammation, but only for a short duration due to potential side effects.

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What are prostaglandins?

Prostaglandins are chemical messengers that promote inflammation, causing pain, swelling, fever, and platelet aggregation.

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How do NSAIDs work?

Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the production of prostaglandins by blocking the enzyme cyclooxygenase (COX).

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COX-1 vs. COX-2

COX-1 is found in most tissues, protecting the stomach and kidneys, and aiding platelet aggregation. COX-2 is mainly found in injured tissues, mediating inflammation.

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What are the adverse effects of inhibiting COX-1?

Inhibiting COX-1 can cause gastric erosion and ulceration, renal impairment, and bleeding.

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What are the adverse effects of inhibiting COX-2?

Inhibiting COX-2 can cause renal impairment, increase risk of heart attack and stroke.

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First-generation NSAIDs

These NSAIDs inhibit both COX-1 and COX-2, providing pain relief and reducing inflammation, but risk more side effects due to inhibiting both enzymes.

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Examples of first-generation NSAIDs

Aspirin (ASA), Ibuprofen (Motrin, Advil), Naproxen (Aleve)

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COX-2 inhibitors: advantages & disadvantages

COX-2 inhibitors are more selective, targeting inflammation with fewer GI side effects, but are associated with increased risk for heart attack and stroke.

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Acetaminophen (Tylenol)

Acetaminophen is a weak COX inhibitor that primarily works in the central nervous system to reduce fever and pain with a less clear mechanism of action.

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Rheumatoid arthritis (RA)

RA is a systemic autoimmune disorder that causes inflammation of the synovial joints, leading to pain, swelling, and joint degradation.

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What are Heberden's and Bouchard's nodes?

Bony growths on the fingers, often associated with osteoarthritis. Heberden's nodes are on the outer joints, Bouchard's on the middle.

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What are the Early Changes in OA?

Early OA features include cartilage damage, narrowing of the joint space, and inflammation of the joint lining.

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What are the Later Changes in OA?

As OA progresses, bone spurs form, bone cysts develop, and cartilage wears away completely, leading to bone grinding on bone.

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Prostaglandins' Role

Prostaglandins are inflammatory messengers that cause pain, swelling, fever, and platelet aggregation. They are chemical messengers that contribute to inflammation.

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How NSAIDs Work

Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the production of prostaglandins by blocking the enzyme cyclooxygenase (COX).

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COX-1 Inhibition: Adverse Effects

Inhibiting COX-1 can cause gastric erosion and ulceration, renal impairment, and bleeding.

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COX-2 Inhibition: Adverse Effects

Inhibiting COX-2 can cause renal impairment, and increase the risk of heart attack and stroke.

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What triggers rheumatoid arthritis?

The presence of an antigen triggers the formation of an abnormal IgG antibody, which sets off a chain reaction in the body that leads to rheumatoid arthritis (RA).

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What's the role of autoantibodies in RA?

The body creates autoantibodies, such as rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), that attack the abnormal IgG. This further amplifies the inflammatory response.

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Immune complexes in RA

The autoantibodies and the abnormal IgG form immune complexes, usually in the synovial membrane of joints. These complexes trigger a strong inflammatory response, leading to joint damage.

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Early RA

The early stage of RA is marked by inflammation and thickening of the synovial membrane. Lymphocytes infiltrate the joint space, contributing to the immune response and ultimately leading to pannus formation.

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Moderate RA

In the moderate stage, the synovial lining becomes even more inflamed and thickened. Granulation tissue develops, and pannus formation intensifies, destroying cartilage and bone at the joint's edges.

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Severe RA

The most severe stage of RA involves significant joint impairment, bone loss, and joint deformity. The inflammatory process continues, causing erosion of bone edges and further instability.

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Articular Cartilage Function

Articular cartilage covers the ends of bones in joints, providing a smooth surface for movement and absorbing shock.

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Distal Interphalangeal Joints

These joints are located at the tips of your fingers and toes, where the finger/toe bone meets the nail bone.

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Primary Goal of Osteoarthritis Treatment

The main goal of treatment is to reduce pain and improve joint function, not necessarily to cure the disease.

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Common Osteoarthritis Symptom

Joint pain that worsens with activity is a hallmark of osteoarthritis.

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Non-Pharmacological OA Management

Heat and cold therapy can help manage osteoarthritis pain.

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Laboratory Test for Rheumatoid Arthritis

A positive rheumatoid factor (RF) test is strongly associated with rheumatoid arthritis.

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Biologic Response Modifiers: Side Effect

Biologics can increase the risk of infection.

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NSAID Patient Instruction

Always monitor for gastrointestinal bleeding when taking NSAIDs.

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What's Pannus?

Pannus is a destructive layer of inflamed tissue that forms in rheumatoid arthritis, eating away at cartilage and bone.

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Study Notes

Osteoarthritis & Rheumatoid Arthritis

  • Osteoarthritis (OA) is a progressive degenerative joint disease
  • Most common sites affected include hips, knees, spine, and hands
  • OA commonly occurs after age 40
  • Risk factors include age, obesity, trauma to joints, and genetic factors
  • OA can be caused by multiple factors, not just a single cause
  • Rheumatoid Arthritis (RA) is a systemic autoimmune disease, meaning the immune system attacks healthy tissues
  • RA commonly affects the synovial joints, leading to inflammation and pain
  • RA targets the connective tissue in synovial joints.
  • RA onset can be gradual or sudden.

Synovial Joint Structure

  • Synovial joints account for about half of all body joints
  • Cartilage cushions and reduces friction in the joint
  • Cartilage degrades over time, leading to wear and tear
  • Synovial membranes produce fluid that nourishes the cartilage and reduces friction
  • The structure of the synovial joint includes bones, cartilage, synovial membrane, synovial fluid, and joint capsule
  • OA changes the composition and quantity of synovial fluid
  • The joint capsule provides stability to the joint
  • Subchondral bone supports cartilage and absorbs movement impact
  • Over time OA leads to reduced ability to absorb impact shock
  • Bone spurs (osteophytes) may develop
  • Cartilage degradation can lead to bone-on-bone contact and pain

Clinical Manifestations of OA

  • Pain - affects quality of life, particularly worse in the morning. Symptoms resolve within 30 minutes
  • Stiffness - noticeable especially in the morning. Can last longer in RA
  • Crepitations - grating sensation arising from the cartilage surfaces.
  • OA can be unilateral
  • Pain and inflammation is a sign of progressive OA

Early Changes in OA

  • Wide space normally present in the cartilage
  • The cartilage structure is significantly damaged or eroded in the early stages of OA
  • Synovium becomes inflamed
  • Cartilage splits and erodes

Later Changes in OA

  • Joint space narrowing due to cartilage loss
  • Bone spurs (osteophytes) form at the edges of the joints
  • Subchondral bone cysts develop underneath the cartilage
  • Loss of cartilage- leads to bone-on-bone contact and pain
  • Increased thickness of the subchondral bone

Clinical Manifestations of RA

  • Morning stiffness for more than 30 minutes
  • Symmetrical involvement (joints affected on both sides of the body)
  • Can affect a range of ages and is commonly found in people between the ages of 30 and 50
  • Other symptoms include pain, inflammation, nodules, fatigue, and fever with anorexia
  • Hand pain is a common symptom in early stages of RA

Pathophysiology of RA

  • A chronic autoimmune disease (body attacks healthy joint tissues)
  • Inflammation of synovial joints are a common factor for RA.
  • Inflammatory response is a response that occurs in early RA stages.
  • Formation of pannus (inflamed synovial tissue)
  • Disrupts joint structure
  • Pannus degrades cartilage and bone
  • Leads to joint damage and reduced mobility

Treatment of OA & RA

  • OA treatment: Primarily focuses on pain management and symptom relief. Non-pharmacological therapies are recommended as the first line of intervention: rest and exercise, physiotherapy,
  • RA treatment: Aims to suppress the immune response and slow down joint damage. Disease-modifying anti-rheumatic drugs (DMARDs) are a critical part of treatment, often used in combination with other therapies such as NSAIDs.

Evaluation of OA & RA

  • Physical and Neurological Exam; specific symptoms are identified at the site of pain
  • Imaging like x-rays is important for diagnosis of early OA
  • Specific blood and joint fluid tests are crucial for determining RA vs OA
  • The analysis of synovial fluid is critical for confirming OA diagnosis.

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Description

Explore the key differences and similarities between Osteoarthritis and Rheumatoid Arthritis in this quiz. Discover risk factors, symptoms, and the importance of synovial joints in joint health. Test your knowledge on these common joint disorders!

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