RA - Clinical presentation

Question 1

What is the definition of RA?

Answer 1

1. Chronic inflammatory autoimmune condition.

2. Characterised by pain, swelling and joint stiffness

Question 2

What is the epidemiology of RA?

Answer 2

Females 50 - 75 years

Question 3

What is the etiology of RA?

Answer 3

1. Unknown cause

2. Associated with HLA DR 4 and HLA DR1 gene

Question 4

What is the pathophysiology of RA?

Answer 4

~ autoimmune inflammatory response~

1. inflammatory joint effusion and synovial hypertrophy,
2. progressive destruction and deterioration of cartilage and bone

Question 5

Name 4 major rhuematoid presentation of RA?

Answer 5

1. Polyarthritis > 4 joints affected
2. Symmetrical
3. Morning stiffness
4. Weakened grip
5. Pain and stiffness relieved by activity

Question 6

What are the 4 distinguishing features of RA found in the hands?

Answer 6

1. Protrusion of the ulnar head at the wrist
   and Ulnar deviation of the fingers
2. Swan neck deformity
3. Bouteniere’s deformity

Question 7

What is the ‘swan neck deformity’

Answer 7

1. Flexion of distal interphalangeal

2. Hyperextention of Proximal interphalangeal

Question 8

What is the ‘Bouteniere’s deformity’

Answer 8

1. Distal interphalangeal joint - hyperextention

2. Proximal interphalangeal is flexed

Question 9

Which 5 major organs are affects in extra articular manifestation of RA?

Answer 9

1. Heart
2. Lungs
3. Skin / Eyes
4. Nervous system

Question 10

What increases the likelihood of extra articular manifestations of RA?

Answer 10

1. Positive rheumatoid factor

Question 11

Extra articular manifestations : Skin

Answer 11

Rheumatoid nodules (non tender, firm swellings)

Question 12

Extra articular manifestations : Heart

Answer 12

1. Pericarditis
2. Endocarditis
3. Increases risk of MI/STROKE
4. Anaemia of chronic disease

Question 13

Extra articular manifestation : Lungs

Answer 13

1. Pleural effusions

2. Pulmonary fibrosis

Question 14

Extra articular manifestation : Nervous system

Answer 14

Peripheral neuropathy

Question 15

Extra articular manifestation : Eyes

Answer 15

1. dry eyes

2. Episcleritis

Question 16

Which joints are commonly affected?

Answer 16

1. Wrists
2. MCP
3. PIP

Question 17

Osteoarthritis vs RA?

Answer 17

1. RA pain is relived by movement whereas OA is exacerbated
2. OA morning stifffness relives < 30 minutes whereas RA > 30 minutes
3. RA is symmetrical whereas OA is asymmetrical