RA Lecture Flashcards
(13 cards)
What areas do RA have a predilection for: Dips, Pips MCP’s?
Pips and MCP’s
List some clinical features/population for RA
- Onset 20-60yo (most common in 40’s)
- Female> Male (approx. 57% women)
- Usually periodic remission/exacerbations with progressive deformity and disability
What are factors that could indicate poor prognosis in RA patients?
- Symmetric polyarthritis
- Subcutaneous nodules, high rheumatoid factor levels
- Sustained episodes of active disease
- Early onset <30yrs
- Extraarticular RA manifestations
Constitutional/Clinical symptoms of RA?
- Fatigue, malaise
- General mm weakness
- Fever, Raynaud’s phenomenon
- Generalized osteopenia
Signs/ Hallmarks of widespread osteopenia?
- Visible trabeculations
- Cortical thinning (cortical margins should be 2/3rds of bone width)
How does RA initially present?
- insidious onset of joint pain, swelling, stiffness and tenderness
- Symptoms worse in the morning
- Bilateral symmetric peripheral joint involvement
- interphalangeal and metacarpal phalangeal initially affected
- 80% of cases eventually end in the Cx spine
List the initial pathological process of RA?
Initially: Scute synovitis, oedema- joint effusion, juxta-articular osteoporosis due to hyperermia
List the subsequent (secondary phase) pathological process of RA?
Subsequently: formation of pannus (vascular granulation of tissue), spreads over intra-articular bone and cartilage
List the resultant (final phase) pathological process of RA?
- Bone destruction
- Pannus erodes into cortex (marginal bone erosion)- presents as a rat-bite erosion
- Pannus protrudes into marrow of subchondral bone producing subchondral cysts
Serological Hallmarks of RA?
- 70% have rheumatoid factor
- Raised ESR levels
What are the 8 radiological findings of RA?
- Symmetrical joint distribution
- Uniform loss of joint space
- Juxta-articular osteoporosis
- Oedema (peri-articular soft tissue swelling)
- Marginal Erosions (rat-bite)- no sclerotic border
- Juxta-articular periostitis (occasional)= solid or singular lamination
- Pseudo cysts (simulates subarticular neoplasms or infection)
- Articular deformity
What’s a relative contraindication in osteopathic techniques of an inflammatory arthridite?
HVLA
What does PARRS stand for in inflammatory arthridites?
P= Psoriatic A A= AS R= Rheumatoid R= Reiters S= SLE (lupus) (These will all affect the AA joint and transverse ligament)
