Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A
  • Most common form of autoimmune
    arthritis
  • Acute and chronic inflammation primarily affects synovial joints
    = Joint destruction
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2
Q

What is a proliferative synovial disease?

A

Joint destruction

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3
Q

What are causes of rheumatoid arthritis?

A
  • Unknown triggers for immune response in synovial tissue
  • Genetics
  • Environmental triggers
  • Hormonal changes
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4
Q

What is involved with genetic cause of rheumatoid arthritis?

A

Determines both risk and severity of disease

HLA-DR4

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5
Q

What are the environmental triggers of rheumatoid arthritis?

A

Bacterial antigens

  • Mycobateria
  • Streptococcus
  • Mycoplasma
  • E.coli
  • H. pylori

Viral antigens

  • EBV
  • Rubella
  • Parvovirus
  • Smoking
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6
Q

What are the risk factors associated with rheumatoid arthritis?

A
Female
Positive family history
Older age
Smoking
Coffee consumption (> 3 cups daily)
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7
Q

Wat are the signs and symptoms of rheumatoid arthritis?

A
  • Insidious onset affecting distal joints first
  • Pain
  • Morning stiffness
  • Swelling and tenderness
  • Systemic symptoms
  • Nodules
  • Pregnancy
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8
Q

What is the hallmark sign of rheumatoid arthritis?

A

Morning stiffness

  • Gel phenomenon
  • Lasting more than an 1 hr
  • Decreases with physical activity
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9
Q

What happens in pregnancy with rheumatoid arthritis?

A

Clinical improvement and postpartum flares

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10
Q

What are the affected joints with RA?

A
Wrists
MCP
PIP
- Flexor tendon  tenosynovitis
MTP
Knees
Elbows
Ankles
Hips
Shoulder
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11
Q

What joints are typically spaired in rheumatoid arthritis?

A

Thoracolumbar spine
Finger DIPs
Toe IPs

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12
Q

What part of the spine is affected by rheumatoid arthritis?

A

C1-C2 articulation

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13
Q

What manifestations occur in hands with rheumatoid arthritis?

A
DIP joints almost never involved
MCP ulnar deviation
Swan-neck deformity
Boutonnière deformity
Nodules
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14
Q

What is included with felty’s syndrome?

A

RA
Splenomegaly
Neutropenia
***Severe RA disease

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15
Q

What are associated with felty’s syndrome?

A

Hepatomegaly
Thrombocytopenia
Lymphadenopathy
Fever

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16
Q

What is the diagnostic criteria for rheumatoid arthritis?

A

NEED 4 of 7

  • Morning stiffness at least 1 hr
  • Arthritis 3 or more joints
  • Swelling of hand joints
  • Symmetrical swelling (soft tissue)
  • Rheumatoid nodules
  • Positive serum rheumatoid factor
  • Xray evidence of erosions &/or periarticular osteopenia in hand or wrist joints

***Stiffness and swelling must be at least 6 weeks

17
Q

What labs are used in diagnostic rheumatoid arthritis?

A
RF
ANA
CBC w/diff
CRP
ESR
Anti-CCP
18
Q

What is Anti-CCP?

A
  • Anti-cyclic citrullinated peptide antibody

- Prognostic value

19
Q

What is the 2010 American College of Rheumatology diagnostic criteria?

A

Joint involvement
Serology
Duration of Synovitis
Acute phase reactants

20
Q

What are the goals for treatment for rheumatoid arthritis?

A

Lifelong disease without cure
Remission
Patient education
Referral to Rheumatologist

21
Q

What are the conservative options for rheumatoid arthritis?

A

Braces
Splints
Orthoses
Medications

22
Q

What are the drug treatment options for rheumatoid arthritis?

A

NSAIDs
Low-dose prednisone
Intra-articular steroid injection
- Flares

23
Q

What do disease modifying antirheumatic drugs (DMARDs) contribute to?

A

Target cytokines or receptors in inflammatory cascade

Decrease monoclonal antibodies

24
Q

What are some examples of disease modifying antirheumatic drugs (DMARDs)?

A

Sulfasalazine
Hydroxychloroquine
Methotrexate/Leflunamide
Cyclophosphamide

25
Q

What are examples of anti-TNF drugs?

A

Infliximab; etanercept

Adalimumab; golimumab

26
Q

What is the surgical treatment of rheumatoid arthritis?

A

Joint replacement

27
Q

Table of osteoarthritis.

A

Age
- Is a factor

Cause
- Joint wear

Symptoms
- Localized to affected joint

Structure
- Articular cartilage

Joint Changes
- “wear and tear”

Hands

  • Heberdon nodes
  • Bouchard nodes
  • 1st MCM joint
28
Q

Table of rheumatoid arthritis.

A

Age
- Is a factor

Cause
- Autoimmune

Family History
- Is a factor

Symptoms
- Joints and systemic

Structure
- Synovium

Joint Changes
- Joint destruction

Hands

  • MCP ulnar deviation
  • Swan-neck deformity
  • Boutonnière deformity