Excellence | Creighton University...Title: Microsoft PowerPoint - RA vs OA Author: tjv69685 Created Date: 9/21/2020 11:20:00 AM

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RHEUMATOID ARTHRITIS VS

OSTEOARTHRITISCorrine A. Giggee, MPAS, PA-C

ABOUT MEPhysician Assistant with CHI Rheumatology

• 14 years of experience in Ortho Spine

• Recent transition to Rheumatology

• Monthly medical column for Small Town Newspaper.

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OBJECTIVES

• Discuss the different features of Osteoarthritis and Rheumatoid Arthritis

• Highlight when to suspect Rheumatoid Arthritis

• Lab tests for diagnosing Rheumatoid Arthritis

• Treatment options for Rheumatoid Arthritis patients.

• Discuss preparing Rheumatoid Arthritis patients for orthopedic surgery

ARTHRITIS

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OSTEOARTHRITIS VSRHEUMATOID ARTHRITIS

Osteoarthritis (OA)

• Common (46% over age 65 in US1)

• Mechanical9

• Men>Women before age 45 Women>Men after age 45

• More common later in life

• Break down of cartilage

Rheumatoid Arthritis (RA)

• Rare (0.24 to 1% worldwide2)

• Autoimmune

• 2-3 times more common in Women

• Can occur at any age, most common 30-50 years

• Chronic inflammation of joint, primarily synovium

SYMPTOMSOA

• Worse with activity

• Morning stiffness<30 minutes

• Bone spurs, bony enlargement, limited ROM

• Can be unilateral, single or multiple joints

• Reduced flexibility

• ‘clicking’ or ‘cracking’ of joints

RA

• Worse with inactivity

• Morning stiffness>30 minutes

• Joint/soft tissue swelling

• Involves small joints

• Symmetrical

• Red or warm joints

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OA VS RA

RA - BEYOND JOINT PAIN

• Fatigue/poor sleep

• Low grade fever/malaise

• Weight loss

• Dry Eyes/Mouth

• Eye inflammation

• Depression

• Lung disease

• Increased risk of CAD/MI

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WHEN TO SUSPECT RA

What does a typical RA

patient look like?

INITIAL DIAGNOSIS

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WORK UP FOR SUSPECTED RA PATIENT

Screening labs:

• Rheumatoid Factor (RF)

• Estimated sedimentation rate (ESR)

• C-Reactive Protein (CRP)

• Cyclic Citrullinated Peptide antibodies (aCCP)

NO PERFECT TEST

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NO PERFECT TEST

NOT ALWAYS STRAIGHT FORWARD…

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TREATMENTSTreat early, prevent progression

MEDICATIONS

• NSAIDs• Naproxen• Meloxicam• Diclofenac

• Steroids• Prednisone• Methylprednisolone• Dexamethasone• Steroid joint injections

• DMARDs• Methotrexate, Hydroxychloroquine,

Sulfasalazine, Leflunomide

• Biologics Anti-TNF: Adalimumab, etanercept,

infliximab, certoizumab JAK inhibitors: Tofacitinib, upadacitinib,

baricitinib T-cell inhibitor: Abatacept IL-6 blocker: Tocilzumab, Anti-CD20: Ribuximab

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EARLY TREATMENT CAN PREVENT/SLOW DISEASE PROGRESSION

STOPPING MEDICATIONS FOR SURGERY

Many of the medications used to treat Rheumatoid Arthritis can also slow healing.

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OA AND RA BOTH CAN REQUIRE REPLACEMENT

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OA AND RA CAN BOTH DO WELL FROM SURGERY

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HOLDING MEDICATIONS

Recommendations from the American College of Rheumatologist and American Association of Hip and Knee Surgeons (2017) 4

HOW TO HAVE THE BEST POST OP COURSE

• Stabilize Rheumatoid Arthritis disease preoperatively• Higher disease activity prior to surgery indicates more likely to flare by 6 weeks. 6,7

• Postoperative flares were not independent risk factors for pain or function scores.7

• Prednisone• Patients who flare post op often have to take a course of prednisone to calm down

symptoms• Prednisone can also cause slowed healing

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THANK YOU!Questions?

REFERENCES

1-Centers for Disease Control and Prevention. Arthritis-Related Statistics. (2018). Retrieved June 25th, 2020 from https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm#projected

2-England, B., Mikuls, T. Epidemiology of, risk factors for, and possible causes of rheumatoid arthritis. In J.R. O’Dell (Ed.), UpToDate. (2019). Retrieved June 25th, 2020 from http://www.uptodate.com/home

3-Gao IK, Haas-Wöhrle A, Mueller KG, Lorenz HM, Fiehn C. Determination of anti-CCP antibodies in patients with suspected rheumatoid arthritis: does it help to predict the diagnosis before referral to a rheumatologist?. Ann Rheum Dis. 2005;64(10):1516-1517.

4-Goodman SM, Springer B, Guyatt G, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or knee arthroplasty. J Arthroplasty. 2017 Sep;32(9):2828–2838.

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REFERENCES

5-Brown, T.A., Shah, S.J. Rheumatology. ; (2017). Retrieved on June 26th, 2020 at https://nursekey.com/rheumatology/.

6-Goodman SM, Bykerk VP, DiCarlo E, et al. Flares in patients with rheumatoid arthritis after total hip and total knee arthroplasty: Rates, characteristics and risk factors. J Rheumatol. 2018 May;45(5):604–611.

7-Goodman, SM et al. Rheumatoid Arthritis Flares After Total Hip and Total Knee Arthroplasty: Outcomes at One Year. Arthritis Care & Research. (2019). Retrieved on June 26th, 2020 at https://doi.org/10.1002/acr.24091

8-Juo,H. (November, 2016) Staying on disease-modifying anti-rheumatic drugs through surgery does not increase post-op infection risk. Presented at American College of Rheumatologist Annual Meeting in Washington, D.C.

REFERENCES

9-Hugle, T et al. Aging an osteoarthritis: An inevitable encounter? J Aging Res. (2012). Retrieved on July 30th, 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376541/

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