rheum week 1

What is osteoarthritis?

Osteoarthritis is the most common joint disease characterized by the degeneration of joint cartilage and underlying bone, often leading to pain and stiffness.

What is the epidemiology of osteoarthritis?

Osteoarthritis is most common in women over 50 years old and younger in men, affecting a significant portion of the population.

What are the aetiological factors of osteoarthritis?

Factors include genetic predisposition, weight, stress and trauma to joints, and occupational hazards.

What is the pathophysiology of osteoarthritis?

It involves the loss of balance between cartilage destruction and formation, leading to osteophyte formation and pain due to friction between bones.

What are the clinical presentations of osteoarthritis?

Symptoms include deep, aching pain that increases with movement, stiffness lasting less than 30 minutes, limited joint motion, and potential joint deformities.

How is osteoarthritis diagnosed?

Diagnosis is based on patient history, clinical signs and symptoms, physical examination, and imaging studies.

What are the treatment goals for osteoarthritis?

Goals include pain management, reducing symptoms, improving quality of life, and maintaining physical function.

What medications are used to treat osteoarthritis?

Medications include NSAIDs, paracetamol, topical agents, and intra-articular steroids, each with specific mechanisms of action and side effects.

What are the side effects of NSAIDs?

Side effects can include gastrointestinal toxicity, cardiovascular risks, and nephrotoxicity, especially in certain populations.

What is the role of hyaluronan in osteoarthritis treatment?

Hyaluronan acts as a lubricant for joints and may reduce pressure on the joint, primarily used in knee osteoarthritis.

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic, systemic autoimmune disease that affects approximately 1% of the population and is more common in females.

What are the aetiological factors of rheumatoid arthritis?

The exact cause is unknown, but genetic factors and certain viral infections may play a role.

What is the pathophysiology of rheumatoid arthritis?

It involves chronic inflammation of the synovial tissue, leading to cartilage thinning, bone erosion, and the activation of immune cells.

What are the clinical symptoms of rheumatoid arthritis?

Symptoms include joint pain and stiffness lasting more than six weeks, joint deformity, fatigue, and symmetrical joint involvement.

What are the extra-articular manifestations of rheumatoid arthritis?

These can include vasculitis, pulmonary effusion, fibrosis, and conditions like Sjogren syndrome and Felty syndrome.

What lab findings are associated with rheumatoid arthritis?

Common findings include anemia, increased erythrocyte sedimentation rate, thrombocytosis, and positive rheumatoid factors.

How is rheumatoid arthritis diagnosed?

Diagnosis involves taking a detailed history of joint pain and swelling, assessing family history, and conducting physical examinations.

What imaging findings are typical in rheumatoid arthritis?

Imaging may reveal osteopenia, joint space narrowing, and bone erosion.

What are the treatment goals for rheumatoid arthritis?

Goals include controlling inflammation, relieving symptoms, preventing joint damage, and maintaining function.

What are the pharmacological treatments for rheumatoid arthritis?

Medications include DMARDs, biologics, NSAIDs, and corticosteroids, each with specific mechanisms and side effects.

What non-pharmacotherapy options are available for rheumatoid arthritis?

Options include physical therapy, occupational therapy, and lifestyle modifications such as exercise and diet.

What is the role of patient education in managing arthritis?

Patient education helps in understanding disease progression, managing symptoms, and setting realistic treatment goals.

Morning stiffness lasting for >1hr

A symptom indicative of rheumatoid arthritis, where stiffness persists for more than one hour upon waking.

Symptoms present for >6 weeks

A criterion for diagnosing rheumatoid arthritis, indicating chronicity of symptoms.

Physical exam findings for RA

Includes swelling, symmetry, symmetrical tenderness, and presence of nodules.

Lab findings for RA

Positive rheumatoid factor, anti-cyclic citrullinated peptide, C-reactive protein, erythrocyte sedimentation rate, and anti-nuclear antibody; bony erosion evident on imaging.

Poor prognosis indicators in RA

High rheumatoid factor and/or positive C-reactive protein, sustained inflammatory markers, swelling in more than 20 joints, impaired function early, bony erosions evident in x-rays early, and smoking.

Treatment goals for RA

Control symptoms, normalize physical functions, ensure participation, prevent joint damage, and minimize systemic damage.

Methotrexate

First-line treatment for RA patients; starts at 10mg once weekly, taken with folic acid on a different day; onset of action is 1-2 months.

Contraindications for Methotrexate

Includes immunocompromised status, active peptic ulcer, active infections, impaired renal function, chronic hepatic disease, and pregnancy/breastfeeding.

Adverse effects of Methotrexate

Nausea, vomiting, diarrhea, oral ulcers, widespread rash, sun sensitivity, lung inflammation, and hepatotoxicity/nephrotoxicity.

Leflunomide

Inhibits dihydroorotate conversion to orotate, reduces inflammation; onset is 1 month; may cause liver enzyme elevation, gallbladder stones, hypertension, and oral thrush.

Hydroxychloroquine

Mechanism of action is not fully understood; onset is 2-6 months; potential side effects include retinopathy, ototoxicity, and altered balance/vertigo.

Sulfasalazine

Metabolizes into 5-ASA and sulfapyridine; reduces inflammatory cell proliferation; onset is 1-3 months; well tolerated but may cause GI side effects, reduced sperm levels, hemolysis, and yellow discoloration.

Azathioprine

Prodrug converted to 6-mercaptopurine, used as an immunosuppressant; not typically used in RA unless severe and unresponsive; requires blood tests to check enzyme mutations.

Biologics in RA

Include TNF-alpha inhibitors that inhibit the inflammatory process; examples are Abatacept, Anakira, Rituximab, and Tocilizumab.

Role of steroids in RA

Fast-acting inflammation reducers used at diagnosis; not recommended for long-term use.

Non-pharmacological treatments for RA

Include light exercise, a Mediterranean diet, quitting smoking, physiotherapy, patient education, and using assistive tools.

Calcium homeostasis

Regulated primarily by parathyroid hormone (PTH), which stimulates osteoclast activity and affects calcium and phosphate levels in the blood.

Bone remodeling process

Involves the balance between osteoblasts (bone formation) and osteoclasts (bone resorption); spongy bone is more metabolically active than compact bone.

Factors affecting bone health

Include physical stress, vitamins and minerals (A, C, K, B12, D, calcium, phosphorus, magnesium), and hormones (insulin-like growth factors, growth hormone, thyroid hormones, estrogen, testosterone).

Structure of a long bone

Includes diaphysis, epiphyses, periosteum, endosteum, medullary cavity, and articular cartilage.

Function of skeletal muscle

Produces movement, maintains posture, supports soft tissues, guards entrances and exits, and maintains body temperature.

Neuromuscular junction

The site where a motor neuron communicates with a muscle fiber, using acetylcholine as the neurotransmitter.

Synovial joints

Characterized by an articular capsule, synovial membrane, articular cartilage, synovial fluid, and bursae.

Compact bone vs. Spongy bone

Compact bone is dense and provides strength, while spongy bone is lighter with many open spaces and is more metabolically active.