arthritis

• differences between rheumatoid arthritis and osteoarthritis

  rheumatoid = autoimmune, inflammatory, any age, symmetrical and require anti-inflammatory medications, symptoms worse in the morning and rapid onset

  osteo = older age, not symmetrical, pain management, degenerative, no joint swelling but limited to joints
• 5 ways to diagnose RA

  CRP levels, presence of boutonierre deformity, ulnar deviation, swan neck, z deformation of thumb and nodules, X rays, DAS-28 and ESR
• describe the pathophysiology of RA

  inflammation in the synovium, joint pain due to irritated nerve endings by inflammatory markers, capsule stretched by swelling in the joint, joint is worn away after repeated flare ups, thinning of cartilage and bone erosion, fragmented capsule and inflamed tendon
• what are the symptoms of RA?

  joints = swelling, swan neck, boutonniere, ulnar deviation, joint swelling and stiffness

  systemic = flu-like symptoms, Raynaud's syndrome, tiredness, irritability and depression, anaemia, feeling generally ill, trapped nerves
• what are the risk factors for RA?

  smoking, drinking a lot of caffeine, eating a lot of red meat
• what are the different treatment options for RA?

  NSAIDS, DMARDs, corticosteroids, biologics
• describe NSAID use in RA?

  COX-2 inhibs more effective, usually use naproxen and ibuprofen

  note: can worsen or trigger asthma, can cause GI irritations - take with food

  Etoricoxib, celecoxib - more selective COX-2 inhibitors
• describe DMARD use in RA?

  immunosuppressive drugs, combinations can imporve effectiveness, include sulfasalazine, methotrexate and leflunomide - interrupts the immune process that causes inflammation - once weekly dose, nausea and vomiting side effects - combat by high dose folic acid supplements
• describe corticosteroid use in RA

  anti-inflammatories, suppresses cytokines, bridging therapy while DMARD takes effectiveness - prednisolone 7.5mg OD - long terms side effects can give you OA and adrenal suppression - can be used in flare ups
• when are biologics used in RA?

  offered if inadequate response to combination DMAARDs
• what is the pathophysiology of OA?

  non-inflammatory, mostly cartilage loss from synovial joints, mostly synovial joints affected, patients often overweight, thinning of cartilage because the bones rub together causing pain and damage to the bone, thickened capsule as well and soteophytes cause swelling in the joints closest to the nail
• what are the risk factors for OA?

  female, over 40, obese, genetics and previous joint injuries consistent with OA
• how is OA diagnosed?

  ask patient about osce style WWHAM questions to determine if its RA or OA, must describe activity related joint pain - should ask about location and onset of pain
• what are the symptoms of OA?

  stiffness, crepitus - creaky joints when moving, pain, not being able to move as freely, wasted muscle
• how is OA managed?

  simple analgesia, injectable corticosteroids, weight loss if applicable, regular reviews to assess response to treatment
• what are the treatments available for OA?

  paracetamol max 4g daily, NSAIDs - watch out for side effects, topical NSAIDS, topical capsaicin then local corticosteroid injections

  could also use non-pharma like better footwear, heat pads or ice packs, muscle strengthening exercises