AssessmentsRheumatoid arthritis and osteoarthritis: Pathology review
USMLE® Step 1 style questions USMLE
A 65-year-old man comes to his primary care provider for evaluation of pain in both knees. His symptoms worsen with activity and improve with rest and ibuprofen. The patient had previously been an avid runner but had to stop due to the joint pain. Past medical history is notable for hypertension and a right fibular fracture, which occurred after a biking accident. Vitals are within normal limits. Examination of the affected joints reveals crepitus and mildly reduced range of motion. The remainder of the patient’s physical examination is noncontributory. Knee imaging is ordered, and the results are as follows:
Reproduced from: Radiopedia
Which of the following additional findings, if present, would best support the patient’s diagnosis?
Jody is a 55 year old woman who presents with a 6 month history of bilateral hand and wrist stiffness.
She mentions that the stiffness lasts for more than an hour a day but tends to improve as she uses the affected joints.
Then you see Kerry, a 60 year old woman who comes in with a 1 year history of pain in the right knee that has gotten progressively worse.
The pain is worse in the evening or with use of the affected limb and is associated with stiffness, which typically occurs at rest and lasts around 10 to 15 minutes.
Examination reveals Kerry is obese, has bowing of the right knee, and that the affected joint has a limited range of motion.
Blood tests are ordered in both cases, showing in Jody’s case high levels of rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA), whereas in Kerry’s case both antibodies were absent.
Both people have arthritis.
Articular cartilage is a type of connective tissue with a lubricated surface that acts like a protective cushion for bones to smoothly glide against.
For example, synovial joints, like those of the wrist, elbow, knees, shoulders, and hips, are mobile joints that connect two bones via a fibrous capsule that is continuous with the periosteum, which is the outer layer of bones.
The fibrous capsule is lined with a synovial membrane that has cells that remove debris and produce synovial fluid, which is a viscous fluid found inside the joint capsule to lubricate the joint.
Together, the synovial membrane and articular cartilage form the inner lining of the joint space.
Now, arthritis refers to a group of diseases that cause destruction of one or more joints, and it can be classified as inflammatory or non-inflammatory.
Inflammatory arthritis is caused by an )immune response attacking the joints.
On the other hand, non-inflammatory arthritis is caused by mechanical wear and tear, and it is mostly represented by osteoarthritis.
Generally, in terms of symptoms, there are a few differences between inflammatory and non-inflammatory arthritis.
Ok so inflammatory conditions are usually accompanied by joint swelling, erythema, prolonged morning stiffness lasting more than one hour, and symmetric pain that improves with use.
Most of these conditions are also associated with extra-articular symptoms, like fever and fatigue.
On the other hand, non-inflammatory arthritis is usually suggested by asymmetric pain that gets worse with use and affects weight bearing joints, like the knee and the hip, and morning stiffness that lasts less than one hour.
Extra-articular symptoms are