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Clinical Medicine I > Rheumatoid Arthritis (RA) > Flashcards

Rheumatoid Arthritis (RA) Flashcards

1
Q

Describe rheumatoid arthritis

A
  • a chronic systemic inflammatory disease
  • presents with articular & extra-articular findings
  • results in gradual destruction of joint tissues
  • often significant deformity & disability
  • affects joints symmetrically
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2
Q

What are the most commonly affected joints for rheumatoid arthritis

A
  • wrists
  • fingers
  • knees
  • ankles
  • feet
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3
Q

What are the risk factors for rheumatoid arthritis

A
  • hormones
  • infection
  • genetics
  • environment
    -associated with autoimmune thyroid & rheumatic diseases
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4
Q

Who is the at risk population for rheumatoid arthritis

A
  • affects all races equally
  • women are 3x more likely then men
  • 2nd most prevalent form of arthritis
  • onset at any age but most common from 30-60 years old
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5
Q

Define pannus

A
  • the thickened synovium with destructive vascular granulation tissue
  • destroys collagen, cartilage, & subchondral bone
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6
Q

Pathogenesis of rheumatoid arthritis

A
  • joint inflammation due to presence of immune cells in synovial fluid
  • cells in synovial lining multiply, leukocytes increase causing edema & synovitis
  • protein destroying enzymes are released causing articular cartilage destruction & synovial hyperplasia
  • swelling, joint pain, deformity, joint instability, & altered biomechanics result
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7
Q

Clinical characteristics of rheumatoid arthritis & symptoms

A
  • begins slowly, cartilage degradation, ligamentous laxity, synovial effusion, & erosion
  • Symptoms: fatigue, weight loss, diffuse musculoskeletal pain, reconditioning, & depression
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8
Q

Joints symptoms of rheumatoid arthritis

A
  • instability, deformity, & laxity
  • MCP & IP early
  • morning stiffness >1 hour
  • joints may feel warm, tender, edematous, & stiff
  • loss of ROM & function
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9
Q

Hand impairments related to rheumatoid arthritis

A
  • swan neck deformity
  • boutonniere deformity
  • ulnar drift
  • thumb MP flexion with IP hyperextension
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10
Q

Describe swan neck deformity

A
  • MCP flexion
  • PIP hyperextension
  • DIP flexion
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11
Q

Knee impairment related to rheumatoid arthritis

A
  • genu valgus
  • baker’s cyst
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12
Q

Ankle/foot impairments related to rheumatoid arthritis

A
  • pronation
  • hallux valgus
  • hammer toes
  • claw toes
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13
Q

Extra-articular manifestations of rheumatoid arthritis

A
  • synovitis, bursitis, tendonitis, fasciitis, neuritis, & vasculitis
  • rheumatoid nodules: surfaces with repeated mechanical pressure
  • increased risk for myocardial infarction & congested heart failure
  • slogan syndrome
  • depression
  • sleep disorders
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14
Q

Diagnosis of rheumatoid arthritis

A
  • American college of rheumatology: synovitis in at least 1 joint & a score of 6 or more
    • serum rheumatoid factor
  • synovial fluid analysis
  • C-reactive protein
  • X-ray
  • MRI
  • ultrasound
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15
Q

Synovial fluid lab testing results with rheumatoid arthritis

A
  • decreased volume
  • increased white blood cells
  • increases protein & protein antibodies
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16
Q

What to look for in imaging for rheumatoid arthritis

A
  • looking for periarticular swelling, cortical thinning, erosion, and joint space narrowing
17
Q

What is the purpose of medical management for rheumatoid arthritis

A
  • reduce pain
  • maintain mobility
  • minimize stiffness & edema
  • prevent joint destruction
18
Q

Pharmacology management for rheumatoid arthritis

A
  • NSAIDs is the 1st choice (ibuprofen & naproxen)
  • corticosteroids for short term only (dexamethasone & cortisone)
  • DMARDS (disease modifying anti-rheumatic drugs) used to slow disease progression
19
Q

Purpose of physical therapy for rheumatoid arthritis

A
  • reduce pain
  • maintain mobility
  • minimize stiffness & edema
  • prevent joint destruction
20
Q

How do we manage rheumatoid arthritis with physical therapy

A
  • education: joint protection, energy conservation, & assistive devices
  • joint protection: avoid positions of deformity, most stable position, & avoid repetitive tasks
  • therapeutic exercise: maintain ROM & focus on activities of daily living (ADL’s)
21
Q

Describe stage I of rheumatoid arthritis

A
  • represents synovitis
  • synovial membrane demonstrates infiltrating small lymphocytes
  • joint effusions
  • no destructive changes present on X-ray
22
Q

Describe stage II of rheumatoid arthritis

A
  • inflamed synovial tissue proliferates
  • encroaching within joint cavity across articular cartilage causing destruction
  • narrowing of joint due to loss os articular cartilage
23
Q

Describe stage III of rheumatoid arthritis

A
  • pannus of synovium
  • erosion of articular cartilage
  • exposed sub-chondral bone
  • X-rays shows extensive cartilage loss & erosions around the margins of joint
24
Q

Describe stage IV of rheumatoid arthritis

A
  • end stage disease
  • inflammatory process is subsiding
  • fibrous or bony ankylosing has occurred
  • nodules

Clinical Medicine I (26 decks)

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