E1 Rheum: RA/OA

What tissue is primarily targeted in RA? What causes this?

Synovium: TNF alpha causes inflammation

What lab findings are associated with RA

Anti CCP antibodies

ANA

RF

pannus formation aka

Fibrosis

Old criteria for RA diagnosis

4/7 for 6+ weeks:

-morning stiffness

-arthritis in 3+ joints

-hand arthritis

-symmetric arthritis

-rheumatoid nodules

-RF +

-erosive changes on XR

New criteria for RA

1 large joint (knee MC) or 2+ other joints

Anti-CCP

What joints are spared in the hand in RA

DIPs

Does RA affect the spine?

ONLY C1-C2 !!

What is a wink sign and what is it associated with?

Wink sign: Atlanto axis subluxation/ cord compression

Associated with RA of the C spine

Best initial diagnostic test for RA of the c spine?

Open mouth views

ABCDs of reading an CR

Alignment

Bony detail

Cartilage

Density

Soft tissue

What are the classic deformities seen in RA of the hands

Swan neck and boutonnière

Which is more common in RA of the KNEES: valgus or varus

VALGUS (can cause knocked knees)

What can you see on a Hip XR of a patient with RA

-acetabular joint narrowed

-acetabulo protrusio

How does RA affect the feet

-hammer toes

-pronation/eversion

-splaying of forefoot

-subtalar joint involvement

Ocular manifestations of RA

-keratoconjunctivitis sicca

-epislceritis

-scleritis

-uveitis

Pulmonary manifestations of RA

Interstitial lung disease (ILD)

Caplan syndrome

What systems are rarely affected by RA alone

GI/renal

#1 cause of death in RA patients

ASCVD

What agents can affect GI/renal systems in patients with RA?

NSAID/steroid use

What is the purpose of DAS 28?

To get RA patients well controlled

First line treatment for RA

Methotrexate (cs DMARD)

MC side effects of methotrexate

-inc LFTs

-mouth sores

-suppression of blood count (Dec CBC)

-lung probs

Methotrexate MOA

inhibits dihydrofolate reductase

What should you always give with methotrexate?

Folic acid

Second line treatment for RA if MTX ain't cutting it

Biologics (TNF inhibs) IN COMBO W MTX

-remicade

-humira

-enbrel

-simponi

TNFs have an increased risk for

-Lymphoma and melanoma

-Drug induced lupus

-Drug induced ANA

Third line treatment for RA

Ts DMARDS (Jak Inhibs)

Jak inhibs have a BBW for what

Inc risk of cardiovascular events

MC form of childhood arthritis

Juvenile idiopathic arthritis (JIA)

What lab findings will you see in JIA

+ ANA

+ anti-CCP

+ RF

Diagnostics/Treatment of TIA

Similar to RA, just <16 y/o

Treat the same

Target tissue for OA

Cartilage

what is the gelling phenomenon? What is it associated with?

stiffness after long periods of sitting or inactivity

Associated with OA (morning stiffness)

Bouchard's nodes vs Heberdens nodes

Bouchard: PIP joint

Heberden: DIP joint

Associated with OA of the hands

Is OA symmetrical?

not always

MC joints in OA

Weight bearing:

-lumbar spine

-knee

-hip

NO wrist/ankles

How to diagnose OA

Mostly Hx/PE

XR: joint space narrowing, osteophytes

What is more common in OA of the knee: valgus or varus

VARUS

What is the Kellgren Lawrence grading scale used for

Grading OA in the knee

0: norm

1: possible osteophytes

2: definite osteophytes

3: multiple osteophytes

4: large osteophytes

What is diffuse idiopathic skeletal hyperostosis (DISH)

3 continuous lumbar vertebra with normal disc high and formation of syndemophytes

What is DISH associated with

DM type 2

Metabolic syndrome

Males >>

First and second line treatment for OA

1. Topical NSAIDs

2. Tylenol/other NSAIDs

What medication should NOT be used to treat OA

Systemic steroids

What type of OA is glucosamine/chondroitin effective in

Moderate to severe OA in the KNEE

Which cox 2 inhibs should be used for treatment of OA? Which should NOT?

Celebrex and Meloxicam

Rofecoxib and Bextra were removed from FDA d/t CVD