Rheumatoid Arthritis Flashcards
(38 cards)
What are the 2 different factors of rheumatoid arthritis?
- Sero-positive RA (rheumatoid factor present)
- sero-negative RA (rheumatoid factor NOT present)
Basic definition of RA?
initially a disease of the synovium with gradual inflammatory joint destruction
What is the most common serious joint disease? and what is the most common joint disease in general
RA is the most common serious
osteoarthritis is the most common
Who does RA affect mostly and what is the peak age range
women
6:1 pre menopause
3:1 post menopause
peaks in 3rd-5th decades ( 20-50 years)
What is the prevalence of RA?
1%
Is RA a slow or fast onset? and how does it usually spread
slow
starts at hands and feet-> proximal spread
potentially all synovial structures
How can RA be described with regards to its total spead and distribution?
symmetrical polyarthritis
(affects joints on both sides of the body equally)
What are the typical symptoms of RA?
fatigue
morning stiffness
joint stiffness
joint pain
minor joint swelling
fever
numbness and tingling
decrease in range of motion
What are the systemic symptoms of RA?
fever
weight loss
anaemia
What are the 3 early signs of RA?
- symmetrical synovitis of:
MCP joints
PIP joints
wrist joints
What are late signs of RA?
- deviation of fingers at MCP joints
- hyperextension of PIP joints (swan neck deformity)
- “Z” deformity of thumb
hyperflexion of MCP
hyperextension of IP joint - subluxation of the wrist
- loss of abduction and external rotation of shoulders
- flexion of elbows and knees
- deformity of the feet and ankles
What is systemic vasculitis?
Inflammation of Blood Vessels
What are the extra - articular features of RA?
caused by systemic vasculitis
psoriasis
scleritis and episcleritis
dry eyes, Sjögren’s syndrome
subcutaneous nodules
amyloidosis
pulmonary inflammation
neurological issues
What are the key investigations for patients with suspected RA?
- radiographs:
look for erosions, loss of joint space and deformity
joint destruction and secondary osteoarthritis
- blood tests:
normochomic, normocytic anaemia
What is the main treatments for RA?
- hollistic management
- improve quality of life
- combinations of physiotherapy, occupational therapy, drug therapy and surgery
How would physiotherapy be carried out for pt with RA?
- keep pt active for as long as possible
- active and passive exercises:
to maintain muscle activity
to improve joint stability
to maintain joint position
How can occupational therapy treat pt with RA?
- maximising the residual function
- providing aids to independent living
- assessment and alteration of home
What drug therapies can be used to treat pt with RA?
-analgesics
(paracetamol, cocodamol
-NSAIDs
(Often combined with anti-PUD agents)
- Disease Modifying Drugs
(hydroxychloroquine, methotrexate,
Less commonly now: sulphasalzine, penacillamine, gold)
- Steroids
( intra-articular )
Give example of disease modifying drugs used to treat RA?
hydroxychloroquine
methotrexate
Give examples of immune modulators used for RA patients?
-biologics (TNF inhibitors such as infliximab, adalimumab)
example of oral steroids for RA?
prednisolone
How can surgery be carried out to treat RA?
- excision of inflamed tissue
- joint replacement
- joint fusion
- osteotomy
(pts often have poor medical condition for surgery)
What is the prognosis for RA?
- 10% spontaneously remit
- fluctuating course
- RF and late onset = worse prognosis
- 10% severely disabled
name some complications of RA with regards to poor prognosis?
- infection
- PUD
- DRUGS
