RA Flashcards
(104 cards)
1
Q
Rheumatoid Arthritis
A
- autoimmune, systemic, inflammatory, chronic condition
- affects synovium
2
Q
Demographics
A
Caucasians, particularly FEMALES between 25-50 years old.
3
Q
Etiology of Rheumatoid Arthritis
A
- Idiopathic/Unknown;
- Microvascular injury triggers the inflammatory process (theory)
4
Q
Main causes of Rheumatoid Arthritis
A
- Infection
- Human Leukocyte Antigen DR4 (HLA DR4)
- Rheumatoid Factor
- Anti Citrullinated Protein Antibody (ACPA)
5
Q
Human Leukocyte Antigen DR4
A
It predisposes individuals to have RA if positive, but DOES NOT CAUSE RA.
6
Q
Rheumatoid Factor (RF)
A
- antibodies vs IgG
- STRONGEST predictor of RA
7
Q
Seropositive vs Seronegative (Rheumatoid Factor)
A
Seropositive > worse prognosis
Seronegative > better prognosis.
8
Q
Anti Citrullinated Protein Antibody (ACPA)
A
- metabolism of dead cells
- most sensitive finding for RA
9
Q
Pathology
A
Synovial T-Cell Proliferation (Pannus formation) > dissolves collagen (Erosion) > leading to IRREVERSIBLE deformities
- aka “Erosive Arthritis”
- not irreversible = not RA
10
Q
1987 Revised Criteria for Classification of RA
A
5-7 can help confirm but does not necessarily diagnose RA
- Morning stiffness (at least 1 hr) : HALLMARK SIGN
- Arthritis of 3 or more joint areas
- Arthritis of hand joints
- Symmetric arthritis
- Rheumatoid nodules
- Serum Rheumatoid factor (+ RF)
- Radiographic changes
If #1-4 is positive for 6 consecutive weeks = highly suggestive of Rheumatoid Arthritis
11
Q
Arthritis of 3 or more joint areas (Polyarticular)
A
at least 3 joint areas have had soft tissue swelling or fluid
12
Q
Symmetric arthritis
A
- SIMULTANEOUS involvement of the SAME joint areas on BOTH SIDES of the body
(bilateral involvement of PIP, MCPs or MTPs is acceptable)
13
Q
Rheumatoid nodules
A
Subcutaneous nodules over:
bony prominence/extensor surfaces/juxta articular regions
14
Q
Radiographic Changes (A B C D E S)
A
Abnormal alignment
Bone involvement
Cartilage destruction
Deformities
Erosion
Soft tissue swelling
15
Q
Top Predictors of RA
A
- Anti Citrullinated Protein Antibody (ACPA)
- Rheumatoid Factor (strongest predictor)
16
Q
2010 ACR/EULAR Classification Criteria for RA
A
Joint Distribution (0-5)
Serology (0-3)
Symptom Duration (0-1)
Acute Phase Reactants (0-1)
17
Q
2010 ACR/EULAR Classification Criteria for RA
A
Definite RA ≥6
18
Q
Score of < 6
A
The patient might fulfill the criteria prospectively over time,
or retrospectively if data on all four domains have been adequately recorded.
19
Q
Small joints in RA
A
MCP
PIP
MTP 2-5
Thumb IP
Wrist
20
Q
Large joints in RA
A
Shoulder
Elbow
Hip
Knee
Ankles
21
Q
Definition of >10 joints in RA
A
- At least ONE small joint;
- additional joints: temporomandibular, sternoclavicular, and others reasonably expected in RA.
22
Q
ESR Formula
A
ESR = (Age + 10) / 2
23
Q
Most commonly affected joints in RA
A
MCP
Wrist
PIP
MTP
Shoulder
Ankle
C Spine
Hip
Elbow
24
Q
Least affected joint in RA
A
TMJ
25
Swan Neck Deformity (Hand)
Flexed DIP, Extended PIP
## Footnote
Cause:
reflex muscle spasm of intrinsics
swelling of the volar capsule of PIP
rupture of EDC at DIP
26
Boutonniere Deformity (Hand)
Extended DIP, Flexed PIP
## Footnote
rupture of the Central Slip.
27
Ulnar Drift 'Z Deformity' (Hand)
Subluxation at the wrist joint
## Footnote
Wrist deviates to radial side, MCP and fingers deviate to ulnar side, leading to absent power grip.
28
Vaughn-Jackson Deformity
Rupture of the 4th and 5th extensor tendon (EDC)
29
Mannerfelt aka Boutonniere Deformity of the Thumb or Nalebuff Deformity
- Rupture of the FPL tendon at the first CMC;
- thumb is in extension.
30
Nalebuff
I. Boutonniere of the Thumb
II. Boutonniere with Add/Sublux. At CMC
III. Swan Neck with Add/Sublux. At CMC
IV. Gamekeeper’s Thumb
V. Swan Neck alone
VI. Bone Loss/Arthritis Mutilans
31
Bone Loss/Arthritis Mutilans
Severe deformity
## Footnote
Includes:
Opera Glass Hand (+) RA
Telescoping Sign (+) PSA
32
Piano Key Sign
(+) Torn DRU Ligament
## Footnote
Up and down movement of the ulna when pressed by the examiner
33
Common knee deformity
- Flexion Contracture (pain relieving position)
- Subluxation
34
Baker's Cyst
Prevents knee extension
35
Hammer Toes (MTP)
Flexed PIP
## Footnote
**Most common foot deformity**, leads to absent push off and apropulsive gait.
(+) Callus formation at PIP Joint
36
Metatarsalgia
Inflamed ball of the foot
37
Hallux Valgus
A condition affecting the big toe, often leading to a bunion.
38
Shoulder Joint
- LOM typically observed 1st of IR, then Add.
- in RA: GH Joint
- in Degenerative Arthritis: AC joint
- Sublaxation: weakness muscles
39
In Rheumatoid Arthritis (RA), which joint is affected?
GH Joint
40
In Degenerative Arthritis, which joint is affected?
Acromioclavicular (AC) Joint.
41
What causes subluxation in the shoulder?
Weakness of muscles.
42
Hindfoot pronation (Ankle)
foot rolls inward during walking
43
Flat foot
collapsed medial arch
44
splay foot
Collapsed transverse arch
45
Cervical spine
- C1 - C2
- laxity of the transverse atlantal ligament (cord compression)
46
Potential fracture associated with C1-C2
Fracture of the Odontoid Process (hangman's/tear drop fracture)
47
Loss of motion (LOM) in the cervical spine
Neck rotation.
48
What can cause subluxation in the cervical spine?
- Compression of the spinal cord
- possible asphyxia
49
management (Mx) for cervical spine issues
Bracing.
50
Pain location in the hip joint
- **Groin** (most common)
- buttocks
- knee
51
Hip joint
LOM: Internal rotation (IR)
52
Common condition of hip joint
Protrusio Acetabuli
53
Elbow joint
- Flexion contracture
- loss of pronation & supination
54
Olecranon Bursitis (Elbow Joint)
Acute: **Student’s Elbow**
Chronic: **Miner’s Elbow**
55
TMJ
Limitation of mouth opening (usually 2 inches)
56
Heart complication of RA
Pericarditis
## Footnote
Includes constrictive pericarditis and cardiac tamponade.
57
Constrictive pericarditis
Enlarged pericardium constricts myocardium causing hypertrophy of myocardium.
## Footnote
Leads to heart hypertrophy, tachycardia, and cardiac arrest.
58
Most common cause of death in RA
Heart impairment/Cardiovascular Disease.
59
Lung complication of RA
Caplan's Syndrome.
## Footnote
aka Coal Worker's Pneumoconiosis
60
PNS Complication of RA
CNS is not affected in RA, only in SLE.
## Footnote
Impingement:
- wrist (CTS)
- elbow (Cubital Tunnel Syndrome)
- knee (Tarsal Tunnel Syndrome)
61
Blood complication in RA
(+) Anemia (anemia of chronic disease/hemolytic).
## Footnote
- WBC & platelets are within **normal** limits
- progress to Felty’s Syndrome
62
Felty’s Syndrome
S L L A A N T
Splenomegaly
Lymphadenopathy
Leukopenia
Arthritis
Anemia of Chronic Diseases
Neutropenia
Thrombocytopenia
63
Eye complication of RA
Sicca Syndrome/Keratoconjunctivitis Sicca
## Footnote
dryness of eyes.
64
Sjogrens Disease (Eye)
aka:
- Autoimmune Exocrinopathy
- Gougerot’s Disease
- Nikulicz’s Disease
65
Triad (Eye)
I. Xerophthalmia (dry eyes)
II. Xerostomia: dry mouth; bilateral parotiditis
III. Arthritis
## Footnote
can lead to (+) Lymphoma
66
Test for Xeropthalmia (Dry eyes)
I. **Schrmer’s Test**: apply filter paper on lower lid
- (+) test, 1st Sjogrens, if wala, RA, if wala, SLE, if wala, Scleroderma, if wala, Mixed Connective Tissue Disease, if wala, NOTA
II. **Rose Bengal Test**
67
Dyspareunia
Painful female sexual intercourse due to dry female genitalia
68
(4) Stages of RA progression
Stage 1 (Mild)
## Footnote
Juxtaarticular Osteoporosis
69
Stage II (Moderate)
Osteoporosis with or without slight bone destruction
**adjacent** muscle atrophy
Rheumatoid nodule
70
Stage III (Severe)
Bone destruction, deformities
**Extensive** muscle atrophy
Rheumatoid nodules
71
Stage IV (Terminal)
Stage III + Bony Ankylosis
## Footnote
Ankylosis is not seen in OA.
72
Functional class of RA
Class I
## Footnote
Individual with self-care vocation & avocational activities
73
Functional class of RA
Class II
## Footnote
Independent with self-care and vocation but limited with avocational activities
74
Functional class of RA
Class III
## Footnote
Independent with self-care but limited with vocation and avocation activities
75
Functional class of RA
Class IV
## Footnote
Dependent (Wheelchair bound)
76
Functional class of RA (Simplified)
Class I: self care, vocational, avocational
Class II: self care, vocational
Class III: self care
Class IV: none
77
Polymyalgia Rheumatica
stiffness and pain of **proximal** muscles (**shoulder, pelvic girdle, and cervical**)
## Footnote
Elderly females, over 50 years old
78
Symptoms of Polymyalgia Rheumatica
Initial symmetrical stiffness
Initial joint involvement asymmetric
Fatigue
Low Grade fever
Muscle pain > Joint pain
79
Ang S E C R E T ni lola poly
Stiffness (proximal muscles)
Elderly
Caucasians
Rheumatism (Knee joint)
ESR Elevated (60-100mm/hr)
Temporal Arthritis (Giant Cell Arthritis)
80
ACR criteria for Polymyalgia Rheumatica
1. Morning stiffness > 45 mins = (2)
2. Hip pain/LOM= (1)
3. (-) RF/ACPA = (2)
4. No other joints involved = (1)
81
Ultrasound findings of Polymyalgia Rheumatica
1. At least 1 shoulder joint with deltoid bursitis or biceps tenosynovitis or glenohumeral synovitis;
at least one hip joint with synovitis or trochanteric bursitis = (1)
2. Both shoulders with deltoid bursitis or biceps tenosynovitis, or glenohumeral synovitis = (1)
82
Positive diagnosis of Polymyalgia Rheumatica
(+) PMR >/= 5
all ACR findings plus at least 1 ultrasound finding
83
Giant Cell Arthritis
Headache
blurring of vision
jaw claudication
scalp pain
affects medium arteries
84
MC Sx: Giant Cell Arthritis
Irreversible blindness
85
ACR criteria for Giant Cell Arthritis
1. Age of onset > 50 years old
2. New headaches
3. Elevated ESR > 50 mm/hr
4. Temporal artery abnormality (pulselessness, tenderness)
5. (+) biopsy of the temporal artery for vasculitis
86
Juvenile Idiopathic Arthritis (JRA/JIA)
I. **Pauciarticular/Oligoarticular** (most common JIA)
II. Polyarticular/Polyarthritis
III. Systemic/Still’s Disease (most rare & severe)
87
Most common type of JIA
Pauciarticular/Oligoarticular JIA
## Footnote
- 1-4 joints
- large joints: knee, ankle, wrist, and TMJ; asymmetric
88
How many joints are affected in Pauciarticular/Oligoarticular JIA?
1-4 joints.
89
Which joints are commonly affected in Pauciarticular/Oligoarticular JIA?
Large joints: knee, ankle, wrist, and TMJ; asymmetric.
90
What is the gender and age prevalence for Pauciarticular/Oligoarticular JIA?
More common in females; ages 1-4 years old.
91
Extended Pauciarticular JIA
If one more joint is added after 6 months
92
Two types of Pauciarticular JIA?
1. (+) ANA and
2. (-) ANA, (+) HLA B27
93
What does (+) ANA indicate in Pauciarticular JIA?
It is associated with iridocyclitis, which can lead to blindness.
94
Polyarticular/Polyarthritis JIA
5 or more joints
95
Gender and age prevalence for Polyarticular JIA
Females, > 8 years old
96
Polyarticular JIA
Small joints of the hands, **symmetrical** (affected)
97
Two types of Polyarticular JIA
(+) RF and (-) RF
98
Prognosis for (+) RF Polyarticular JIA
Worst prognosis due to organ involvement (5-10%)
99
Prognosis for (-) RF Polyarticular JIA
Better prognosis with complete remission (95%)
100
Systemic/Still's Disease
rarest and most severe type of JIA
101
Gender prevalence for Systemic/Still's Disease
Equal prevalence in males and females.
102
Key symptoms of Systemic/Still's Disease
(+) High Grade Fever
Daily
OD
Still's Rash.
103
Characteristics of Still's Rash
Salmon Pink color
disappears with depression of fever, and is nonpruritic.
104
