RA

Question 1

What membranes become inflamed in RA

Answer 1

Synovial

Question 2

In response to _______ factors, synovial membranes become inflamed

Answer 2

immunologic

Question 3

Synovitis

Answer 3

Inflammation of the synovial membrane

Question 4

4 features of synovitis

Answer 4

1. hyperplasia
2. increased vascularity
3. infiltration of inflammatory cells
4. Articular damage caused by pannus

Question 5

Pannus

Answer 5

granulation tissue formed within synovium

Question 6

Genetic factors associated with RA

Answer 6

• familial history (2x)
• prevalence in monozygotic twins (identical): 15-35%
• ” in dizygotic (fraternal): 5%

Question 7

Prevalence of rheumatoid factor (RF) in people with RA

Answer 7

80%

Question 8

RF accounts for about __% of the genetic risk for RA

Answer 8

30%

Question 9

Ratios for positives of RF in RA+

Answer 9

Normal 1:20
Grey Zone: 1:20-1:80
Positive: 1:160

Question 10

Elevated RF in 5-10% of healthy persons > 60 years old

Answer 10

Dang

Question 11

Increased/decreased risk of RA onset after childbirth?

Answer 11

Increased

Question 12

Increased/decreased risk of RA onset following breast feeding and why?

Answer 12

Increased, associated with increased prolactin

Question 13

Oral contraceptive use appears to increase/decrease risk of RA

Answer 13

decrease, likely postponing the disease onset

Question 14

Increase/decrease risk with cigarette smoking

Answer 14

increase, especially in men

Question 15

Cigarette smoking associated with seropositive/negative RA?

Answer 15

Seropositive RA

Question 16

Occupations associated with increased RA risk

Answer 16

Miners and farmers

Question 17

reduced risk with what foods?

Answer 17

• olive oil
• fish > 3/week
• tea > 3/day

Question 18

7 criteria for an RA diagnosis

Answer 18

1. Morning stiffness > 1 hour (> 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 RF positive
7. Radiographic changes

Question 19

How many criteria out of 7 are needed for a diagnosis?

Answer 19

Greater than or equal to 4

Question 20

Clinical features of RA

Answer 20

Pain, fatigue, stiffness, decreased ROM, small joints (MCP, PIP, MTP, IP), often symmetrical, swelling, joint deformity, muscle atrophy, extra-articular features

Question 21

RA nodules are typically found….

Answer 21

Under the skin in elbow, finger, wrist, hips, lower back, Achilles tendon, lung/heart tissue

Question 22

RA nodules found 7% of the time at initial diagnosis, 30% of patients during disease

Answer 22

Mem

Question 23

Traditional DMARD

Answer 23

Disease modifying Anti-rheumatic drugs to halt the disease process

Question 24

Biologic DMARD

Answer 24

Halt the disease process

Question 25

NSAID

Answer 25

Manage pain and inflammation

Question 26

Acetominophen

Answer 26

pain control

Question 27

corticosteroids

Answer 27

rapidly reduce pain and improve function

Question 28

First line treatment for RA

Answer 28

DMARD: used early, can prevent irreversible joint damage

Question 29

Aim of treatment

Answer 29

Pt with new disease: achieve and maintain remission | Pt with long-standing disease: achieve and manage low disease activity

Question 30

Rehab goals during acute phase

Answer 30

Control/decrease inflammation, control pain - balance rest & activity, energy conservation - Ice - Splints/positioning - ROM exercises

Question 31

Should you add stretches to an acute pt's program?

Answer 31

No: synovial membrane is already distended and can cause further damage

Question 32

Rehab goals during chronic phase

Answer 32

- patient education - improve pain and stiffness (modalities, positioning, supports, splints, exercise ROM + strengthen, energy conservation) - increase function and activity - prevent deformity - address muscle imbalance - skills for self-management

Question 33

Skills needed for self-management

Answer 33

- Problem solving - Self monitoring - communication skills

Question 34

Education pieces

Answer 34

- Stop smoking - therapeutic exercise, physical activity - avoid being sedentary - resources and other health care members

Question 35

4 R's of surgery

Answer 35

- Remove: synovectomy, MTP resection - Re-align: tendon rupture repairs - Rest: arthrodesis (surgical fusion) of ankle, wrist, C1-C2 - Replace: knee, hip, ankle, shoulder, MCP arthroplasties

Question 36

Potential FITT prescription

Answer 36

30-60 minutes/day, 1-2x per week