Respond  on two different days who selected different factors than you, in one or more of the following ways:

Offer alternative diagnoses and prescription of treatment options for osteoarthritis and rheumatoid arthritis.

Share an insight from having read your colleague’s posting, synthesizing the information to provide new perspectives.

                                                         Main Post

                                                                    Arthritis

            Arthritis is an inflammation of the joints. It can affect one joint or multiple joints. There are more than 100 different types of arthritis, with different causes and treatment methods. Two of the most common types are osteoarthritis (OA) and rheumatoid arthritis (RA) (Macon, B, Guy, L. 2017). 

Osteoarthritis: Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of your bones wears down over time. Osteoarthritis can occur in any joint, it mainly affects the hands, knees, hips, and spine. 

Rheumatoid Arthritis: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by the persistent symmetric inflammation of multiple peripheral joints. It is characterized by the development of a chronic inflammatory proliferation of the synovial linings of diarthrodial joints, which leads to aggressive cartilage destruction and progressive bony erosions

Pathophysiology of Osteoarthritis and Rheumatoid Arthritis

            In both cases involving OA and RA, the etiology is fully not understood. The pathophysiology of OA articular cartilage is played by cell/extra-cellular matrix (ECM) interactions, which are mediated by cell surface integrins. “OA is a complex disease whose pathogenesis includes the contribution of biomechanical and metabolic factors which, altering the tissue homeostasis of articular cartilage and subchondral bone, determine the predominance of destructive over productive processes” (Lannone F, et al. 2003). In RA, damage is centered around the synovial linings of joints the synovium normally provides nutrients and lubrication to adjacent articular cartilage. RA synovium, in contrast, is markedly abnormal, with a greatly expanded lining layer (8–10 cells thick) composed of activated cells; a highly inflammatory interstitium replete with B cells, T cells, and macrophages; and vascular changes, including thrombosis and neovascularization” (Hammer, G. D., & McPhee, S. J, 2019).

Factors: Age and Genetics

            Many factors can play a role in OA and RA. The causes of RA and OA still remain unclear, there is several links to genetic and environmental factors that have been identified that predispose to the development of RA and OA.  Genetics is the first factor that plays a significant role in the development of RA and OA. In OA there is rare genetic defect that causes the body’s production of collagen to be disrupted, this can cause an early diagnosis. Another is an inherited trait where the bones don’t line up correctly causing wear and breakdown on the cartilage. Researchers have discovered the Gene FAAH that could be a cause of OA. With RA it can be a combination of genetics and environmental factors. “The most significant genetic risk factors for rheumatoid arthritis are variations in human leukocyte antigen (HLA) genes, especially the HLA-DRB1 gene. The proteins produced from HLA genes help the immune system distinguish the body’s own proteins from proteins made by foreign invaders (such as viruses and bacteria). Changes in other genes appear to have a smaller impact on a person’s overall risk of developing the condition” (NIH, 2019). RA affects women more than men possibly due to hormones changing in women with age. 

Treatment and Diagnosis of RA and OA

            Diagnosis RA in early stages can be difficult because early signs and symptoms mimic other disease. To diagnosis RA and OA, MRI or X-ray can help in diagnosis of the disease and progression. There is no blood test for OA but RA, laboratory test like ESR, or sed rate or C-reactive protein (CRP), Most of the time the levels will be elevated (Mayo Clinic, 2019), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. There is a physical exam that can determine redness, swelling, and pain in the joints, and will also check for reflexes and strength. There is no cure for OA or RA, but treatment with Disease-modifying antirheumatic drugs (DMARDs) can slow the progression and with RA can sometimes put patients in remission. 

References

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical 

medicine (8th ed.). New York, NY: McGraw-Hill Education.

Iannone F, et al. (2003). The pathophysiology of osteoarthritis. Aging Clinical and Experimental 

Research.15(5):364-72. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/14703002/?ncbi_mmode=std

Macon, B, Guy, L. (2017). Arthritis. Retrieved from https://www.healthline.com/health/arthritis

Mayo Clinic. (2019). Rheumatoid arthritis. Retrieved from https://www.mayoclinic.org/diseases-

conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653

Mayo Clinic. (2019). Osteoarthritis. Retrieved from https://www.mayoclinic.org/diseases-

conditions/osteoarthritis/diagnosis-treatment/drc-20351930

National Institute of Health. (2019). Rheumatoid arthritis. Retrieved from 

https://ghr.nlm.nih.gov/condition/rheumatoid-arthritis#resources