Rheumatoid Arthritis Revision Questions

Question 1

What is RA

Answer 1

intially a disease of the synovium with gradual inflammation joint destruction
early morning stiffness exceeding 30mins - lasting 6weeks or longer

Question 2

Symptoms of RA

Answer 2

Slow onset - initial hands and feet, proximal spread, protential all synovial joints, symmetrical polyarhtirits, fever, weight loss, anaemia
Atlanto - occipital instability

Question 3

Early signs of RA

Answer 3

symmetric synovitis of meta- carpal and proximal pharnygeal joints
Syymetric synovitis of wrist joints

Question 4

Late stages of RA

Answer 4

ulnar deviation of fingers and meta carpal pharnygeal joints
hypertension of proximal pharyngeal joints - swan neck deformity
Z-deformity of thumb - hyperflexion of meta carpal pharyngeal
Hyperextension of IP joint
subluxation of wrist
loss of abduction and external rotation of shoulder
flexion of elbow and knees
deformity of feet and ankles

Question 5

Extra articular features of RA

Answer 5

inflammation of blood vessels
sjorens and dry eyes
psoriarsis nodules - pressure points
pulponary inflammation
neurological

Question 6

Treatment for RA

Answer 6

Physio - aim to keep patient active for as long as possible, maitain muscle acitivity and improve joint stability

Ocupational - improve residual capactiy and aid to independent living
Drugs - anagelsics - paracetamol, cocodamol
- NSAIDS
- disease modifying drugs - hydroxycholoroquinone, methatrexate
- steriods - intra-articular and orally given

Surgery - excision of inflammed tissue, joint replacment, joint fusion, osteotomy

Question 7

Dental Aspects of RA

Answer 7

reduced dexterity and access to care
Sjorens syndrome - association of CT disorders - dry eyes and mouth
Joint replacement - sometimes TMJ
Chronic anaemia - Watch GA

Drug effects - bleeding - NSAIDs

                  - infection risk - steriods and azathroprine
                  - oral lichenoid reactions
                  - oral ulcerations - methotrexate
                 - oral pigmentation - hydrocychloquinone

Question 8

Sero negative spondyloartthritides

Answer 8

associted with HLA-B27
often have symmetrical peripheral arthritis
ocular and mucocutanoues manifestations

Question 9

Ankylosing Spondylitis

Answer 9

HLA B27 positive
spinal joint arthritis - fusion of facet joints (inabiliy to move)
young onset at 20
limited back and neck movement
limited chest expansion
cervical spine tipper forward

Question 10

Treatment for ankylosing spondylitis

Answer 10

analgesia and NSAIDs
physio and occupational therapy
DMDs
Immune modulators
surgery if needs joint replacement

Question 11

Dental Aspects of ankylosing spondylitis

Answer 11

GA hazardous - due to limited mouth opening and neck flexion

TMJ joint involement sometimes

Question 12

Reiter’s Disease/ Reactive arthritis

Answer 12

autoimmunine inflammatory condition trigger by an infection
often associated with IBD
Develops 10-14 days after being trigger by infection
often trigger by campylobacter or salmonella