Rheumatoid Arthritis Flashcards
what is RA
peripheral, symmetrical, predominantly small joint arthritis
a chronic inflammatory disease
an auto immune process
multi system involvement
synovial inflammation
factors increasing risk of RA
3x more common in females
higher risk in 12 months post partum
smoking
infection: ?EBV, HHV-8, P acnes, P gingivalis
diagnosis of RA is based on
clinical diagnosis
criteria for RA diagnosis
- morning stiffness
- arthritis in three or more joint areas
- arthritis of hand joints (1 or more swollen joints)
- symmetric arthritis
- rheumatoid nodules
- serum RF
- radiographic changes (erosions) on x-rays of hands
4 of the 7 criteria must be present
criteria 1 through 4 must have been present for at least 6 weeks
differentiating inflammatory pain vs. mechanical pain
inflammatory: acute/subacute, morning stiffness, improves with activity
mechanical: chronic, progressive, worse with activity, better at rest
DIP extension and PIP flexion
boutonniere deformity
PIP extension and DIP flexion
swan neck deformity
pulmonary manifestations of RA
pleuritis, pleural effusion, alveolitis
cardiac manifestations of RA
pericarditis, valvular heart disease, pericardial effusion
ocular manifestations of RA
keratoconjunctivitis sicca, episcleritis, scleritis
neurological manifestations of RA
peripheral neuropathy, nerve entrapment, myelopathy
cutaneous manifestations of RA
palmar erythema, pyoderma gangrenosum
haematological manifestations of RA
neutopaenia/splenomegaly, hyper viscosity
autoantibodies assisting with diagnosis in RA
rheumatoid factor: not necessarily specific for RA
anti CCP antibodies: 98% specific
markers of disease activity
platelets: thrombocytosis
CRP (C reactive protein)
ESR (erythrocyte sedimentation rate)
