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Y4 Acute Care > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is RA?

A

Chronic inflamm systemic symmetric autoimmune disorder

(pneumonic = CISSA disorder)

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2
Q

What is the relationship between RA and CV diseases?

A

Increases risk by 2-3x bc faster atherosclerosis

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3
Q

What is the cause of RA?

A

Unknown

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4
Q

What are the risk factors of RA? (3 things)

A
  1. Obesity
  2. Smoking
  3. Female (3:1)
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5
Q

What are the general clinical features of RA? (3 things)

A
  1. Symmetrical swelling
  2. Pain + pain on motion
  3. Morning stiffness
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6
Q

What is the difference between the EARLY and LATE signs of RA?

A 
Early = inflamm but NO joint damage 
Late = joint damage + deformities
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7
Q

What are the early signs of RA? (3 things)

A
  1. Swollen wrist, MCP, PIP, MTP
  2. Tenosynovitis (inflamm of synovium in tendon sheath)
  3. Bursitis
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8
Q

What are the late signs of RA? (4 things)

A
  1. Ulnar deviation of wrist
  2. Swan neck deformity (DIP)
  3. Boutonniere deformity (PIP)
  4. Hitchhiker thumb / Z deformity
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9
Q

What is a Swan neck deformity?

A

PIP hyperextension + DIP flexion

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10
Q

What is a Boutonniere deformity?

A

PIP flexion + DIP hyperextension

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11
Q

What is a Hitchhiker thumb / Z deformity deformity?

A

MCP flexion + IP hyperextension

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12
Q

What percentage of patients have Extra-articular manifestations of RA?

A

40%

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13
Q

What are the GENERAL Extra-articular manifestations of RA? (3 things)

A
  1. Fever
  2. Fatigue
  3. Weight loss
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14
Q

What are the NODULAR Extra-articular manifestations of RA? (4 things)

A

Nodes in:

  1. Elbows
  2. Lungs
  3. Heart
  4. CNS
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15
Q

What are the LUNGS Extra-articular manifestations of RA? (3 things)

A
  1. Pleural disease
  2. Interstitial fibrosis
  3. Organizing pneumonia
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16
Q

What are the CARDIAC Extra-articular manifestations of RA? (3 things)

A
  1. IHD
  2. Pericarditis
  3. Pericardial effusion
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17
Q

What are the NEURO Extra-articular manifestations of RA? (2 things)

A
  1. Carpel tunnel
  2. Peripheral neuropathy
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18
Q

What are the EYES Extra-articular manifestations of RA? (3 things)

A
  1. Episcleritis
  2. Scleritis
  3. Scleromalacia
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19
Q

What is an OTHER Extra-articular manifestations of RA?

A

Splenomegaly

20
Q

What investigations should be done for RA? (4 things)

A
  1. Serology
  2. Bloods
  3. Synovial fluid analysis
  4. Imaging
21
Q

What are the Serological investigations that should be done for sus RA? (2 things)

A
  1. RhF (rheumatoid factor) (+ve in 70% pt)
  2. anti-CCP (98% specificity)
22
Q

What are the Blood results of RA? (4 things)

A
  1. Low Hb (sign of anaemia of chronic disease)
  2. High platelets
  3. High ESR (inflamm marker)
  4. High CPR
23
Q

What are the results of Synovial fluid analysis of RA?

A
  1. Leukocytosis
  2. -ve gram stain
  3. -ve gram culture
  4. -ve for crystals
24
Q

What are the early XR findings of RA? (4 things)

A
  1. Could be normal
  2. Loss of joint space
  3. Juxta-articular osteopenia
  4. Soft-tissue swelling
25
Q

What are the late XR findings of RA? (2 things)

A
  1. Bony erosions
  2. Subluxation (partial dislocation of joint)
26
Q

What are MRI / CT scans better than XR for in RA?

A

For diagnosing synovitis

27
Q

What are the diagnostic criteria for RA? (4 things)

A 
A = Joint Swelling 
B = Serology 
C = Acute phase reactants 
D = Duration of symptoms
28
Q

What is the points system for Joint Swelling for the diagnosis of RA?

A

1 large joint = 0
2-10 large joints = 1
1-3 small joints = 2
4-10 small joints = 3
10+ joints (at least 1 small) = 5

29
Q

What is the points system for Serology for the diagnosis of RA?

A

-ve RF AND anti-CCP = 0
Low +ve RF OR anti-CCP = 2
High +ve RF OR anti-CCP = 3

30
Q

What is the points system for Acute phase reactants for the diagnosis of RA?

A

Normal CPR AND ESR = 0
Abnormal CPR OR ESR = 1

31
Q

What is the points system for Duration of symptoms for the diagnosis of RA?

A

Less than 6 weeks = 0
6 weeks + = 1

32
Q

How many points from the points system are diagnostic of RA?

A

6 points

33
Q

What are some differentials of sus RA? (2 things)

A
  1. OA
  2. Gout
34
Q

How do you differentiate a diagnosis between OA and RA?

A

OA = -ve RF + anti-CCP

35
Q

How do you differentiate a diagnosis between Gout and RA? (2 things)

A
  1. Gout = monoarticular
  2. Gout = has crystals in synovial fluid
36
Q

What is the goal of management of RA?

A

Refer to rheumatologist to prevent deformity + permanent damage

37
Q

What are the Conservative management options for RA? (3 things)

A
  1. Physiotherapy
  2. Occup therapy
  3. Smoking cessation
38
Q

What are the Acute exacerbation management options for RA? (2 things)

A
  1. NSAIDs
  2. Steroids (reduce Swelling)
39
Q

What are the Long term management options for RA? (3 things)

A

DMARDs (for all patients)

40
Q

What is the most common DMARD?

A

Methotrexate

41
Q

What are the side fx of Methotrexate (DMARD)? (3 things)

A
  1. Myelosuppression (reduced bone marrow activity)
  2. Cirrhosis
  3. Pneumonitis
42
Q

What are the indications for surgery of RA? (2 things)

A
  1. Severe damage
  2. Limited function
43
Q

What are the surgical options for RA? (3 things)

A
  1. Joint replacement
  2. Joint fusion
  3. Synovectomy (removing synovium membrane that lines joint)
44
Q

What are the benefits of surgery for RA? (3 things)

A
  1. Relieve pain
  2. Improve function
  3. Prevent deformity
45
Q

What are the risks of surgery for RA? (4 things)

A
  1. Bleeding
  2. Infection
  3. DVT / PE
  4. Loosening of prosthetic parts

Y4 Acute Care (31 decks)

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