Rheumatoid Arthritis

Question 1

What is the most common inflammatory disease?

How common is it?

Answer 1

RA

1% of all adults

Question 2

Which gender does RA affect more frequently?

Answer 2

Women (2-3x more)

Question 3

Etiology of RA

Answer 3

Unknown

Thought to be genetic, environmental, or autoimmune

Question 4

What joints does RA affect?

Answer 4

Proximal interphalangeal/metacarpophalangeal joints of hands and feet

Question 5

What joints does OA affect?

Answer 5

Weight bearing joints and distal interphalangeal joints

Question 6

Phases of RA

Answer 6

Exacerbations and remissions

Question 7

What is found in 70-80% of all patients with RA?

Answer 7

Circulating auto-antibodies aka rheumatoid factors

Question 8

Effect of inflammatory cytokines in RA

Answer 8

Erosion of articular surfaces and destruction of adjoining cartilage, tendons, and ligaments

Question 9

Rheumatoid factors effect on immune system

Answer 9

Immune assault

Question 10

Rheumatoid factors effect on skeletal structures

Answer 10

Dislocation and dissolution of skeletal structures

Question 11

Implications of deformed joints

Answer 11

Have no stability and minimal range of motion

Question 12

What aspects of a joint are effected by RA?

Answer 12

• Cartilage
• Ligament
• Tendon
• Bone

Question 13

What are the four TNF inhibitors used in RA?

Answer 13

• Etanercept (Enbrel)
• Infliximab (Remicade)
• Adalimumab (Humira)
• Golimumab (Simponi)

Question 14

Effects of RA on the heart

Answer 14

Aortic or mitral regurg

Pericardial effusion

Question 15

What is included in Felty’s Syndrome?

Answer 15

• RA
• Splenomegaly
• Neutropenia

Question 16

How is peripheral neuropathy most commonly manifested in RA?

Answer 16

Carpal tunnel

Question 17

Effects of joint involvement in RA

Answer 17

• Limits ROM
• Severe pain
• Joint instability
• Crippling deformities

Question 18

What are the 3 most important joints affected in RA?

Answer 18

• TMJ
• Cricoarytenoid
• Atlanto-axial

Question 19

Effects of cricoarytenoid joint involvment in RA

Answer 19

Cricoarytenoid joints of larynx may be swollen, inflamed, or fixed in a position that obstructs flow

Mucosa may be friable

Question 20

What percent of RA pts have sensation of foreign body?

Answer 20

17

Question 21

What percent of RA patients have hoarsenss

Answer 21

15

Question 22

What percent of RA pts have sensation of fullness

Answer 22

14

Question 23

What percent of RA pts have dyspnea?

Answer 23

10

Question 24

Effect of TMJ involvement in RA

Answer 24

Flexion contractures and soft tissue swelling may lead to marked limitation in ability to open jaw

May only be able to open mouth 1-2 cms

Question 25

What percent of RA pts have TMJ involvement?

Answer 25

30-80%

Question 26

Effects of extensive C-spine involvement in RA

Answer 26

* Instability * Limited movment of neck * Severe laryngeal deviation

Question 27

Most common site of c-spine involvment in RA

Answer 27

C1-C2

Question 28

What medications may RA pt be on that we need to ask about?

Answer 28

* NSAIDs * Steroids * Methotrexate * TNF inhibitors

Question 29

How to evaluate how advanced cervical spine involvement is?

Answer 29

MRI, c-spine xray

Question 30

What RA patients need even more careful positioning?

Answer 30

Osteopnic and patients on steroids

Question 31

What to assess for after extubation of RA patient?

Answer 31

Post-extubation laryngeal edema or stridor

Question 32

How may eyes be effected in RA?

Answer 32

Dry eyes Sjogren's Syndrome