JOINT DISORDERS 1 · the elbows, knees and ... Common joints involved include the first...

JOINT DISORDERS 1

1. All of the following are common in idiopathic osteoarthritis (OA) of the knee EXCEPT:

A) Age > 50

B) Bony tenderness

C) Stiffness

D) Erythrocyte sedimentation rate (ESR) > 40

OA = It is commonly characterized as “wear and tear arthritis.”

old age, large joints young age, small joints

degenerative autoimmune

cartilage degeneration synovial inflammation

Cartilage Synovial membrane

Cartilage is a connective tissue found in many areas of the body including: Joints between bones e.g. the elbows, knees and ankles.

The synovial membrane is a specialized connective tissue that lines the inner surface of capsules of synovial joints and tendon sheath.

2. Rheumatoid arthritis (RA):

A) Is primarily a non‐inflammatory disorder of weight‐bearing joints

B) Primarily affects the distal interphalangeal (DIP) joints

C) Is more prevalent in females than in males

D) Is also known as “wear and tear” arthritis

Epidemiology of RA

Prevalence of 1%

More common in _______ than _______ (female:male ratio of 3:1)

Peak onset is in the fourth or fifth decade for women and the sixth to eighth decades for men

40% of RA patients are registered as disabled within 3 years of onset, and around 80% are moderately to severely

disabled within 20 years

OA RA

JOINT DISORDERS 1

HB Kim, www.AcupunctureMedia.com

3. All of the following are common in idiopathic osteoarthritis (OA) of the knee EXCEPT:

A) Palpable warmth

B) Negative rheumatoid factor (or low titer)

C) Bony enlargement

D) Bony tenderness

OA RA

Physical

Exam

reduced range of motion

joint misalignment

crepitus

synovitis

symmetrical joint involvement

joint destruction

4. Which of the following is true about rheumatoid arthritis (RA)?

A) Asymmetric and nonerosive

B) Symmetric and erosive

C) Asymmetric and erosive

D) Symmetric and nonerosive

RA is a systemic autoimmune inflammatory disorder of unknown etiology that affects multiple organ systems.

It affects the musculoskeletal system and specifically the synovial lining of diarthrodial joints.

Diarthrodial joints contain type II hyaline cartilage, subchondral bone, synovial membranes, joint capsule, and synovial fluid.

It is a chronic, symmetric, erosive synovitis that develops in the joints and leads to joint destruction.

Erosions are specific to RA.

OA RA

Radiology presence of ___________

joint space narrowing

___________ on x‐ray or MRI

synovitis noted by ultrasound or MRI

Laboratory clear synovial fluid

ESR or C‐reactive protein

Anti‐CCP

Rheumatoid factor

5. Which of the following is associated most strongly with obesity in women?

A) Hip osteoarthritis

B) Rheumatoid arthritis

C) Knee osteoarthritis

D) Lupus

OA of the knee is associated with obesity in women.

JOINT DISORDERS 1


6. A reasonable first line of treatment in osteoarthritis (OA) of the knee is:

A) Intra‐articular injections

B) Oral steroids

C) Acetaminophen and/or nonsteroidal anti‐inflammatory drugs (NSAIDs)

D) Colchicine

The other choices are used in inflammatory arthritis, or as treatments for refractory OA,

but not as a first‐line treatment.

7. Which of the following are characteristic of rheumatoid arthritis (RA)?

A) Morning stiffness

B) Symmetric arthritis

C) Arthritis of the hand joints

D) All of the above

Morning stiffness lasting more than 1 hour, arthritis of three or more joints simultaneously affected with soft‐tissue swelling,

arthritis of the hand joints including the wrist/metacarpophalangeal joint/proximal interphalangeal joint, symmetric arthritis of

the same joints on both sides of the body, rheumatoid nodules (subcutaneous nodules over the extensor surfaces), positive

serum rheumatoid factor, and radiographic changes such as erosions/joint space narrowing are all characteristics of RA.

Not all are necessary for diagnosis.

OA RA

Patient

History

palpable bony joint enlargement

morning stiffness (lasting < ______ mins)

pain

pain duration > 6 weeks

morning stiffness (lasting > ______ mins)

systemic symptoms (e.g. fatigue, anorexia)

8. Which of the following are characteristics of osteoarthritis (OA)?

A) Dull, aching pain better with activity

B) Joint stiffness lasting < 30 minutes and improving as the day progresses

C) Typically involves the metacarpophalangeal (MCP) joints in the hands

D) Infrequently involves the spine

OA is characterized by joint stiffness worse in the morning, lasting less than 30 minutes and improving as the day goes on.

JOINT DISORDERS 1


9. What causes a Boutonnière deformity?

A) Rupture of the extensor hood at the PIP, which causes subluxation of the lateral bands of the extensor hood

B) Flexor synovitis

C) Ligamentous laxity

D) Rupture of the flexors with subluxation causing hyperextension at the PIP

Boutonnière deformity is characterized by weakness or rupture of the terminal portion of the extensor hood,

which holds the lateral bands in place at the PIP joint.

There is initially PIP synovitis then a downward slippage of the lateral bands, causing flexion at the PIP joint.

RA: Deformity

Swan‐neck deformity Boutonniere deformity

______ flexion + PIP hyperextension ______ flexion + DIP hyperextension

OA: Swollen, hard and painful finger joints

Heberden’s node Bouchard’s node

10. Match the OA Nodes to the correct joints.

Heberden’s node ■ □ distal interphalangeal joints

Bouchard’s node ■ □ proximal interphalangeal joints

11. Match the RA Deformity to the correct definitions.

Swan‐neck deformity ■ □ PIP flexion + DIP hyperextension

Boutonniere deformity ■ □ DIP flexion + PIP hyperextension

JOINT DISORDERS 1


12. Which of the following is NOT a characteristic radiographic finding in osteoarthritis (OA)?

A) Asymmetric narrowing of the joint space

B) Erosive changes seen on x‐ray

C) Subchondral bony sclerosis

D) Osteophytosis

In patients with OA, characteristic changes on x‐ray are as follows: asymmetric narrowing of the joint space, no

erosive changes on x‐ray, joint involvement that does not have to be symmetric, no osteoporosis or osteopenia,

osseous cysts, subchondral bony sclerosis, osteophytosis, and loose bodies.

Common joints involved include the first carpometacarpal joint, distal interphalangeal joints, knees, and hips.

Joint space Osteophyte Sclerosis

narrowing bone spur hardening

KGZSP

1. Radix Rehmanniae Preparata

2. Herba Pyrolae

3. Herba Cistanches Deserticolae

4. Herba Epimedii Grandiflori

5. Caulis Spatholobi

6. Rhizoma Cibotii

7. Fructus Ligustri Lucidi

8. Semen Raphani Sativi

9. Radix Achyranthis Bidentatae

10. Rhizoma Drynariae

(Shu Di Huang)

(Lu Xian Cao)

(Rou Cong Rong)

(Yin Yang Huo)

(Ji Xue Teng)

(Gou Ji)

(Nu Zhen Zi)

(Lai Fu Zi)

(Niu Xi)

(Gu Sui Bu)

Indications: bone spur, osteoarthritis

13. What is the most serious complication of osteoarthritis (OA) of the cervical spine?

A) Radiculopathy

B) Myelopathy

C) Osteoporosis

D) Chronic pain

Cervical ___________ (spinal cord compression) is the most serious complication of OA of the cervical spine.

Although nerve roots can become impinged because of osteophytes (radiculopathy) as well, it is not as serious

as spinal cord compression.

Cervical myelopathy from OA usually requires surgical intervention.

Chronic pain can be associated with OA, but is not as serious as myelopathy.

JOINT DISORDERS 1


14. Which of the following exercises is recommended for rheumatoid arthritis?

A) Isotonic contraction

B) Concentric contraction

C) Eccentric contraction

D) Isometric contraction

____________ contraction of a muscle does not cause a change in muscle length or joint angle and is ideal for

RA because it allows the joint to rest.

Isotonic contractionIsometric contraction

Concentric contraction Eccentric contraction

muscle shortens

(↓length)

muscle lengthens

(↑length)

muscle contracts but dose not shorten

(↑tension, ↔length)

upward phase of exercise downward phase of exercise holding the weight still

15. Match the Contractions to the correct definition.

Isometric contraction ■ □ Muscle shortens

Isotonic – Concentric contraction ■ □ Muscle lengthens

Isotonic – Eccentric contraction ■ □ Tension builds but muscle neither shortens or lengthens

16. A swan neck deformity is noted in your patient. Which condition is most likely, and which area would have a hyperflexion deformity?

A) Osteoarthritis, proximal interphalangeal joint (PIP)

B) Rheumatoid arthritis, proximal interphalangeal joint (PIP)

C) Osteoarthritis, distal interphalangeal joint (DIP)

D) Rheumatoid arthritis, distal interphalangeal joint (DIP)

Rheumatoid arthritis is an autoimmune disease resulting in inflammation in tissue and joints.

The disease affects the digits of the hand.

Swan neck deformity is caused by a rupture of the lateral retinaculum of the extensor tendon at the PIP joint, resulting in

hyperextension of the PIP joint and hyperflexion of the DIP.

Osteoarthritis results from generalized wear and tear on the body with progressive degeneration of joints, including cartilage,

bone, synovium, muscles, and ligaments. Rheumatoid arthritis is more commonly found in women, whereas osteoarthritis has

more equal sex distribution.

Rheumatoid arthritis is commonly diagnosed as early as age 20, whereas osteoarthritis affects those above age 40.

JOINT DISORDERS 1


17. What is the position of a swan‐neck deformity of the finger typical in rheumatoid arthritis?

A) Hyperextension of the proximal interphalangeal joint (PIP) with hyperextension of the distal interphalangeal joint (DIP)

B) Hyperextension of the PIP with flexion of the DIP

C) Flexion of the PIP with flexion of the DIP

D) Flexion of the PIP with hyperextension of the DIP

A __________ deformity can be seen in the hands of rheumatoid arthritis patients and is hyperextension

of the PIP with flexion of the DIP.

There is also flexion at the metacarpophalangeal joint (MCP).

It is caused by chronic inflammation at the PIP, which causes a stretch of the volar plate. The PIP joint

then moves into hyperextension.

At the DIP, there is elongation or rupture of the extensor hood at the base of the phalanx.

18. Which of the following is NOT a characteristic radiographic finding in rheumatoid arthritis (RA)?

A) Erosion of the ulnar styloid

B) Marginal bony erosions

C) Asymmetric joint involvement

D) Uniform joint space narrowing

In patients with RA, characteristic changes on x‐ray are as follows: uniform joint space narrowing, symmetric joint

involvement, marginal bony erosions, juxta‐articular osteopenia, ulnar deviation of phalanges, radial deviation of the

radiocarpal joint (carpal and metacarpals), erosion of the ulnar styloid, atlantoaxial subluxation, and small joint

involvement, including metacarpophalangeal joints, proximal interphalangeal joints, and carpal joints.

19. What is the earliest radiographic sign of rheumatoid arthritis?

A) Diffuse periarticular osteopenia

B) Ulnar deviation of the phalanges at the metacarpophalangeal joints (MCP)

C) Periarticular erosions

D) Pencil‐in‐cup deformity

Early radiographic findings: Diffuse periarticular osteopenia is the earliest radiographic sign of rheumatoid arthritis.

Joint space narrowing and periarticular erosions may be observed later (usually within 2 years of the disease).

Later radiographic findings: Other deformities such as ulnar deviation of the MCP, radial deviation of the wrist,

and swan‐neck deformities are later findings.

20. What is the “gold standard” for diagnostic imaging in rheumatoid arthritis (RA)?

A) Ultrasound

B) Magnetic resonance imaging (MRI)

C) Plain radiograph

D) Bone scan

Plain radiograph remains the “gold standard” for diagnostic imaging in rheumatoid arthritis.

JOINT DISORDERS 1


21. Which of the following is NOT a part of rehabilitation of the hand in a patient with rheumatoid arthritis?

A) Resting the involved joints

B) Heavy exercise of the involved joints

C) Joint protection instructions

D) Splinting regimens

In RA, it is important to rest the involved joints.

Heavy exercise of the involved joints is contraindicated as it could cause more damage.

Other important rehabilitation measures include modification of activities that stress the joints, joint protection,

work simplification instructions, splinting regimens, heat modalities followed by active range of motion exercise,

and resistive exercise.

22. Heberden’s nodes are a common feature in which of the following disease processes?

A) Rheumatoid arthritis

B) Septic arthritis

C) Osteoarthritis

D) Gouty arthritis

Heberden’s nodes are osteoarthritis enlargements in the DIP joints and appear in more than half of patients with _________.

Repeated trauma causes these osteophyte formations to develop and may cause joint stiffness and tenderness.

23. Pain relieved by activity is a feature of which of the following types of arthritis?

A) Osteoarthritis

B) Rheumatoid arthritis

C) Septic arthritis

D) Gouty arthritis

Morning stiffness is a feature of nearly all types of arthropathies, but rheumatoid arthritis has classically been noted

to have morning stiffness lasting longer than an hour and relieved by movement.

24. Which of the following is the most destructive element of rheumatoid arthritis?

A) Joint erosion

B) Pannus formation

C) Crystalline formation

D) Rheumatoid nodules

______ is an abnormal layer of fibrovascular tissue or granulation tissue.

Pannus is a tissue derived from synovial membrane that causes destruction of cartilage and bone.

Multinucleated cells with osteoclastic characteristics have been identified in the pannus–bone interface.

This destruction can lead to instability of joints and eventual fibrosis, becoming the leading cause of

morbidity in patients with rheumatoid arthritis.

JOINT DISORDERS 1


25. Symmetric erosive destruction of multiple joints is more likely to be seen in which of the following arthropathies?

A) Osteoarthritis

B) Reactive arthritis

C) Rheumatoid arthritis (RA)

D) Gout

RA usually presents as morning stiffness in multiple joints.

RA is caused by autoimmune destruction of unknown etiology.

Current American College of Rheumatology criteria for rheumatoid arthritis include:

(1) morning stiffness lasting for at least 1 hour

(2) involvement of three or more joints

(3) involvement of at least one joint in the hand

(4) symmetric involvement of joints

(5) rheumatoid nodules

(6) positive rheumatoid factor

(7) radiographic evidence of erosions or decalcification of joints

At least ______ of the seven criteria must be met for diagnosis.

26. All of the following are true regarding rheumatoid arthritis EXCEPT:

A) 85% of cases are rheumatoid factor (+)

B) Rheumatoid nodules are present

C) More common in males

D) Inflammation of the synovial capsule

Rheumatoid arthritis is more common in females than in males.

Rheumatoid arthritis is an inflammatory disorder that primarily affects synovial joints.

Inflammation of the capsule around the joints, known as the synovium, is the first step in this destructive disease.

Nodules are present in about 50% of patients with rheumatoid arthritis and are located most commonly over the

pressure points of joints.

JOINT DISORDERS 1


JOINT DISORDERS 1 · the elbows, knees and ... Common joints involved include the first...

Documents

Transcript of JOINT DISORDERS 1 · the elbows, knees and ... Common joints involved include the first...