Clinical Approach to RA, Seronegative Arthropathies and Gout Flashcards
(48 cards)
What produces RF?
What does RF do?
B-cells of RA synovium.
RFs fix complement, which recruits PMNs.
What imaging modality is most sensitive in detecting erosions in hands and feet?
CT
What ethnicity tends to have the greatest amount of people affected with RA?
Yakima and Intuit NA tribes
When does RA tend to improve? When do symptoms recur?
Which infections are associated with RA? (3)
Pregnancy; flares begin 4-6 wks.
Periodontal disease bacteria (?), EBV and Parvovirus B19.
What 2 features should suggest testing for RA?
Patients with at least 1 joint with definite clinical synovitis.
The synovitis is not better explained by another disease.
What 2010 RA classification scales score suggests definite RA?
Score >6/10 = definite RA.
How many “points” are given for the following:
1 large joint 2-10 large joints 1-3 small joints 4-10 small joints > 10 joints (at least 1 small)
1 large joint = 1 pt. 2-10 large joints = 2 pt. 1-3 small joints = 2 pt. 4-10 small joints = 3 pt. >10 joints (at least 1 small) = 5 pt.
How many “points” are given for the following:
-RF and - anti-CCP
Low +RF or low +anti-CCP
High +RF or high +anti-CCP
Acute phase reactants:
NL CRP and NL ESR
Abn. CRP or Abn. ESR
Duration of symptoms:
< 6 wks.
> 6 wks.
-RF and - anti-CCP = 0
Low +RF or low +anti-CCP = 2
High +RF or high +anti-CCP = 3
NL CRP and NL ESR = 0
Abn. CRP or Abn. ESR = 1
< 6 wks. = 0
> 6 wks. = 1
What is the use of monitoring acute phase reactants in RA?
To track the response to treatment.
Which hand joint does RA typically spare?
What part of the spine does it tend to affect?
DIPs.
C1-C2
What is pannus?
An abnormal layer of fibrovascular tissue overlying the synovial joint.
If you see this, the patient is ALWAYS RF+:
Rheumatoid nodules
In RA, active signs of inflammation last at least…
> / 6 wks.
Which patients are more likely to have extra-articular RA symptoms?
Those with +RF or +anti-CCP.
What vascular/skin lesions may be seen in RA? (2)
Pyroderma gangrenosum: a tender purple papule that leads to a necrotic, non-healing ulcer.
Rheumatoid vasculitis: purpura, petechial, splinter hemorrhages leading to digital infarct.
What cardiac diseases can be seen in patients with RA?
CAD, HF, pericarditis all due to chronic endothelial inflammation.
What pulmonary diseases can be seen in patients with RA? (4)
Pleuritis - most common.
Interstitial lung disease (ILD)
Caplan syndrome - nodular densities after exposure to coal or silica dust.
Pulmonary fibrosis
What is keratoconjunctivitis?
What disease is it seen in?
Dryness of conjunctiva and cornea (most common eye manifestation in Sjogren’s or SLE).
Sjogren syndrome (Sjogren’s exists in up to 35% of patients with RA).
What ANA positivity suggests Sjogren syndrome?
What 2 other tests can be done to test for it?
Anti-Ro/SS-a, Anti-La/SS-B (salivary gland involvement).
Schirmer’s test
Slit-lamp exam
What are features of Feltys syndrome? (4)
RA
Splenomegaly
Neutropenia, Anemia, Thrombocytopenia
+RF and +anti-CCP
What may cause peripheral neuropathy and cervical myelopathy in RA patients?
Atlantoaxial subluxation (C1-C2) due to erosion of the odontoid process.
What is the role of TNF in RA?
It stimulates synovial cell proliferation and collagenase (destroys cartilage).
Spondylitis
Spondylolistesis
Spondylolysis
Spondylitis = vertebral inflammation.
Spondylolistesis = anterior displacement of a vertbral body.
Spondylolysis = defect of the portion of bone between the inferior and superior articular process of the vertebrae (pars interarticularis).
What is the most common inflammatory disorder of the axial skeleton (and SI joints)?
Which sex is more common?
When does it onset?
Ankylosing spondylitis
Males 3:1
2nd to 3rd decade
