00:00 / 00:00
Rheumatoid arthritis and osteoarthritis: Pathology review
0 / 15 complete
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.
Rheumatoid arthritis is an autoimmune inflammatory disease that causes progressive and symmetric destruction of at least three joints, especially the proximal interphalangeal joints, which leads to morning stiffness that lasts for more than an hour and improves with use. It can also present with extra-articular symptoms like uveitis, pulmonary fibrosis, and rheumatoid nodules. The treatment of rheumatoid arthritis involves non-biological and biological DMARDs, nonsteroidal anti-inflammatory drugs (NSAIDs), and glucocorticoids.
Osteoarthritis, on the other hand, is a chronic condition characterized by the breakdown of joint cartilage and underlying bone followed by inadequate repair. Now, unlike rheumatoid arthritis, which is an autoimmune disorder, osteoarthritis is considered a mechanical degenerative joint disorder. This is because the main culprit seems to be the daily stress applied to joints in our lifetime, especially to weight-bearing joints like those of the ankle, knee, and hip. Symptoms of OA include joint pain, stiffness, and decreased range of motion. Treatment of OA involves losing weight, physical therapy, and pain management with drugs like acetaminophen and NSAIDs.
Copyright © 2023 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Cookies are used by this site.
USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.