Osteoarthritis vs. Rheumatoid Arthritis

What is the anti-CCP test?

- Anti-CCP antibodies are the most specific blood test for RA - Anti-CCP is an autoantibody produced by the patient's immune system that attacks the body. These attacks can produce inflammatory symptoms most commonly experienced in rheumatoid arthritis

Joints most commonly affected by osteoarthritis include...

- PIPs and DIPs of hands (fingers) - MCP of the thumb (metacarpophalangeal) - weight-bearing joints (knees, hips) - cervical and lumbar spine

Although any joint may be affected the most commonly involved joints in rheumatoid arthritis are...

- PIPs of fingers - MCP joints - wrist - knees - ankles - MTP (metatarsophalangeal joints)

What are the signs and symptoms of osteoarthritis?

- Pain (pain is the most common symptom of osteoarthritis and usually increases with joint use; pain can also restrict mobility) - Stiffness (stiffness of the affected joint is often noticed first thing in the morning, and after resting) - Swelling - Deformity (painless, irregular bony enlargements; Herbeden's nodules and Bouchard's nodes) - Crepitus (bone grinding on bone)

What are the essentials Rheumatoid Arthritis?

- Usually insidious onset with morning stiffness and joint pain. - Symmetric polyarthritis with predilection far small joints of the hands and feet; deformities common with progressive disease. - Rheumatoid and antibodies to cyclic citrullinated peptides (anti-CCP) are present in 70-80% - Extra-articular manifestations: subcutaneous nodules, interstitial lung disease, pleural effusion, pericarditis

What are the ocular symptoms associated with RA?

- dryness of the eyes (can increase risk of eye disease) - dryness of the mouth and other mucus membranes

What are the risk factors of osteoarthritis?

- genetics (predisposition to breakdown of cartilage in FHx) - repetitive movements - trauma (secondary) - elevated BMI - old age

What are the symptoms of rheumatoid arthritis?

- insidious onset of morning stiffness and joint pain - symmetrical polyarthritis (patients can experience unilateral disease) - predilection for small joints, particularly hands and feet - weight loss - fatigue - muscle weakness - vague musculoskeletal complaints that eventually settle into joints - morning stiffness (lasts about an hour; takes time for muscle to relax and become functional) - flare-ups (cyclical onset); want to elongate periods between flare-ups

What systemic diseases are associated with RA?

- interstitial lung disease (makes lungs thicker, less pliable) - paracharditis (inflammation of paracardium ("baggy" that surrounds heart) - disease of the lung pleura (lungs have plueral spaces)

What are the treatments for RA?

- medications - biological response modifiers

What is the general information to know about rheumatoid arthritis?

- most common inflammatory arthropathy - onset 4th or 5th decade - P>M 3:1 - inflammatory response (chronic inflammation of the synovium (synovitis) erodes cartilage, bone, ligaments and tendons) - effusion and other manifestations of inflammation are common - unabated - disability becomes pronounced

What is the general information to now about osteoarthritis?

- non-inflammatory disease - characterized by progressive degeneration of joint cartilage with bone margin involvement and osteophyte formation

What are the essentials of osteoarthritis?

1. A degenerative disorder with minimal articular inflammation. 2. No systemic symptoms. 3. Pain relieved by rest; morning stiffness brief. 4. Radiographic findings: narrowed joint space, osteophytes.

What medical treatments are used to treat osteoarthritis?

1. Acetaminophen - Tylenol 2. Nonsteroidal anti-inflammatory (NSAIDs) - Motrin, Advil, Celebrex 3. Intra-articular injections of triamcinolone and lidocaine

What are the labs for RA?

1. Anti-cyclic citrullinated peptide (anti-CCP) 2. Rheumatoid factor

What are the medications for RA?

1. Low-dose corticosteroids (prednisone) produce a prompt anti-inflammatory effect and slow the rate of articular erosion. 2. Sulfasalazine 3. Methotrexate - a long standing medication used to Treat RA Methotrexate increases adenosine levels. Adenosine promotes anti-inflammatory state Taken once per week - by mouth or IM injection (thigh) Adversely impacts body's folic acid levels via GI tract - thus patients often take folic acid supplements along with methotrexate. Adverse effect - possible liver damage - pts are often advised to avoid alcohol and monitor LFTs (liver function tests)

What are physical exam findings for rheumatoid arthritis?

1.) Joint findings 2.) Rheumatoid nodules 3.) Ocular symptoms 4.) Systemic disease

it is estimated that everyone over the age of ____________ suffers from osteoarthritis.

75

What are the three joint findings of rheumatoid arthritis?

A. Polyarticular joint edema, erythema and pain, often at rest B. Swan-neck and Boutonniere deformities C. Ulnar deviation at MCPs

What are biological response modifiers?

Biological response modifiers are the newest class of disease-modifying antirheumatic drugs (DMARDs) used to treat rheumatoid arthritis

What joints do Herbeden's nodules affect?

DIPs

What are the generic and brand names of the biological response modifiers?

Etanercept (Enbrel) Adalimumab (Humira) Infliximab (Remicade)

Do biologics cure RA?

No, but they can dramatically slow its progression

What is the definition of osteoarthritis?

Osteoarthritis is a chronic long-term, degenerative disease that causes the breakdown of cartilage in the joints leading to pain and stiffness.

What joints do Bouchard's nodes affect?

PIPs

What is TNF?

TNF is a protein in the immune system that contributes to inflammation and joint damage.

What does surgical intervention for osteoarthritis do?

Total hip and knee replacements provide excellent symptomatic and functional improvement when involvement of that joint severely restricts walking or causes pain at rest, particularly at night.

All three of the biological response modifiers are...

Tumor Necrosis Factor (TNF) blocker

What are the rheumatoid nodules?

Twenty percent of patients have subcutaneous rheumatoid nodules, most commonly situated over bony prominences but also observed in the bursae and tendon sheaths.

What is the prognosis for osteoarthritis?

a. No cure b. Manage pain and minimize disability c. Maintain quality of life d. Encourage exercise - strength and joint function e. Depression associated with chronic pain

What is the rheumatoid factor test?

an antibody that is detectable in the blood of approximately 80% of adults with RA

What do TNF blockers do?

block the action of TNF that leads to damage from abnormal inflammation.

____________ percent of people over _________ years of age are affected by osteoarthritis in at least _________ joint.

fifty; 60; one

What is the surgical intervention for osteoarthritis?

joint arthroplasty (arthroscopic procedure)

Before the age of 45, osteoarthritis predominantly affects...

men

What are DMARDs genetically engineered to act like?

natural proteins in the patient's immune system

What labs are done for osteoarthritis?

no blood studies (radiographic findings)

What is primary osteoarthritis?

primary osteoarthritis has an unknown cause but is generally associated with aging. It is sometimes referred to as "wear and tear" arthritis.

What test is used to diagnose osteoarthritis?

radiograph (x-ray)

"The primary objectives in treating rheumatoid arthritis are...

reduction on inflammation and pain, preservation of function, and prevention of deformity."

What is secondary arthritis?

secondary osteoarthritis is the destruction of cartilage from a known cause. Conditions that lead to cartilage loss include repetitive trauma, obesity, crystal deposits, infection, congenital abnormalities, injury or joint surgery.

What does an x-ray of osteoarthritis show?

shows joint space narrowing and osteophyte formation

After 55, the condition of osteoarthritis is more frequent in...

women