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 Page 1 HB Kim, www.AcupunctureMedia.com
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JOINT DISORDERS 1 · the elbows, knees and ... Common joints involved include the first carpometacarpal joint, distal interphalangeal joints, knees, and hips. Joint space ... Repeated
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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 Page 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.
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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 Page 3
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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.