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PHTH 565 RHEUMATOLOGY > RA > Flashcards

RA Flashcards

(53 cards)

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1
Q

Are women or men more likely to have RA

A

women

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2
Q

When is the onset for RA

A

35-50

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3
Q

Which populations have the highest levels of RA? The lowest?

A

Aboriginal

Asian

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4
Q

What is the pathophysiology of RA

A

Autoimmune disease

- In response to immunologic factors synovial membranes become inflamed

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5
Q

What triggers RA

A

Genetic susceptibility and environmental triggers

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6
Q

What are the characteristics of synovitis

A
  • Hyperplasia (synovial cell proliferation)
  • Increased vascularity
  • Infiltration of inflammatory cells - resulting in the production of enzymes that causes inflammation
  • Articular damage cased by pannus
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7
Q

what is pannus

A

granulation tissue formed within synovium

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8
Q

What is the difference between joint damage in OA and RA

A

In an RA affected joint damage is throughout the joint surface (unlike OA where you see the most damage near site of stress)
- In RA there can also be bone damage leading to osteoporosis

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9
Q

What happens when a joint is affected by RA

A
  • In response to immunologic factors, the synovium becomes swollen and cells begin to proliferate
  • A densely cellular membrane )pannus) spread over the cartilage and erodes the underlying cartilage and bone
  • Pannus can cause fibrous scar tissue, adhesions, and ankylosis on opposite articular surfaces
  • Bone becomes more osteopenic, ligaments and tendons are damage, surrounding muscle deteriorates
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10
Q

What is the response of the synovium to immunologic factors

A

becomes swollen and cells begin to proliferate

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11
Q

What is the result of pannus spreading over the articulare cartilage

A

erodes the underlying cartilage and bone

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12
Q

What is the result of pannus spreading to the opposite articular surface

A

creates fibrous scar tissue, adhesions, and ankylosis

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13
Q

What is the result of tendon and ligament damage in RA

A

increased risk of rupture

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14
Q

What is the result of ligament damage and deteriorating musculature

A

leaves joints unstable and prone to deformity

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15
Q

Familial history of RA increases overall risk by ___

A

2x

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16
Q

What is the genetic marker for RA

A

Rheumatoid factor HLA-DR4

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17
Q

Rheumatoid factor (RF) HLA-DR4 is present in ___% of people with RA

A

80%

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18
Q

Rheumatoid factor (RF) HLA-DR4 accounts for ___% of the genetic risk in RA

A

30%

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19
Q

High RF can also be present in people with what conditions?

A

Lupus, syphilis, chronic or idiopathic pulmonary fibrosis

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20
Q

when else might you see elevated levels of RF

A

in aging population - 5-10% of healthy people>60yrs have it

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21
Q

What are the risk factors for RA

A
  • Genetics
  • Pregnancy & hormonal factors
  • Environmental factors - Smoking, occupation, diet,
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22
Q

What occurs to your risk of RA following child birth

23
Q

What may be a reason for why risk of RA increases following child birth

Study These Flashcards
A

breast feeding - associated with increased prolactin

24
Q

Oral contraceptive use Increases or decreases you risk of RA

Study These Flashcards
A

decreases by postponing disease onset

25
What are the findings for risk of RA in those using postmenopausal hormones
inconsistent
26
smoking use Increases or decreases you risk of RA
increases - especially in men
27
What type of RA is smoking associated with
seropositive RA
28
Which occupations are associated with a risk in RA
Miners (silica exposure) | Farmers (pesticide exposure)
29
Which dietary choices are associated with decreased risk of RA
- Olive oil consumption - Fish consumption (>3times/week) - Drinking tea (>3cups/day) - antioxidants
30
What are the 7 criteria for RA
1. Morning stiffness >1 hours (>6 weeks) 2. Arthritis of > 3 joints (>6 weeks) 3. Arthritis of hand joints (>6 weeks) 4. Symmetric arthritis (>6 weeks) 5. Rheumatoid nodules 6. Serum rheumatoid factor positive 7. Radiographic changes
31
How many RA criteria need to be met for a diagnosis
4 or more
32
Clinical features of RA
- Pain - Fatigue - Stiffness - decreased ROM - often involves small joints - often symmetrical - swelling - joint deformity - Instability of the joint - Muscle atrophy, general deconditioning - Extraarticular features
33
When the disease is quieted down - what are acceptable training levels
you can train at high intensities
34
Where do rheumatoid nodules develop?
subcutaneously in elbow, finger, wrist, hip joints, lower back and achilles tendon Occasionally in heart and lung tissue
35
rheumatoid nodules are found in ___% of people at the time of diagnosis
7%
36
Rheumatoid nodules affect __% of patients are some point during their disease
30%
37
What sensations occur during the warming or stress relief of raynauds patients
- Numb, prickly feeling or stinging pain
38
Raynauds is present is ____ of RA patients
17%
39
What are the 4 major management areas for RA
- Medications - Rehabilitation interventions - Lifestyle modification/self-management - surgery
40
What are 5 types of medications for RA
1. Traditional DMARD 2. Biologiv DMARD 3. NSAID 4. Tylenol 5. Corticosteroid
41
Which medication is the first line of treatment
DMARD
42
What are DMARDs used for
to halt the disease process - prevent irreversible joint damage
43
What is the consequence of not using DMARD
premature death
44
What is the downside to DMARDs
very expensive
45
What is the target of treatment for people with a new RA diagnosis
Achieve and maintain remission
46
What is the target of treatment for people with establish long-standing RA diagnosis
achieve and maintain low disease activity
47
When is medication escalated
until the target is reached and promptly modified when the target is no longer
48
Is typical or biological DMARD more effective
Biological
49
What is the goal of rehabilitation interventions in the acute phase of RA
Control/decrease inflammation, control pain
50
What are the modes of rehabilitation intervention in the acute phase
- Balance rest & activity - ICe - Splints - ROM exercises
51
Should you stretch an acutely inflamed joint? why?
No because the synovial membrane is already distended
52
What are the goals of rehabilitation interventions in the chronic phase of RA
1. Improve knowledge of RA and active self management 2. Improve pain and stiffness 3. Increase function & activity level 4. Prevent deformity 5. Address muscle imbalances
53
What are the 4 Rs of surgical management
- Remove - synovectomy, MTP resection - Re-align - tendon rupture repairs - Rest - Arthrodesis (surgical fusion) of the ankle, wrist, C1-C2 - Replace - Arthroplasty hip, knee, ankle, shoulder, MCP joints

PHTH 565 RHEUMATOLOGY (7 decks)

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