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Pathology Exam 2 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What are demographics for patients with RA?

A

1% of adult USA population

increase with age and anglo-saxons

ages 30-50

3:1 female to male ratio

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2
Q

How does RA affect mortality?

A

can shorten life by 3-18 years

pts unresponsive to MTX usually shorter life

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3
Q

Why does RA reduce life span?

A

infection, heart disease, respiratory failure, renal failure, GI disease

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4
Q

What are the two types of arthritis classifications?

A

mono and polyarticular

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5
Q

What is classified as monoarticular?

A

infection, trauma, gout

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6
Q

What is classified as polyarticular?

A

inflammatory- RA, SLE, AS, Psoriatic

degenerative and metabolic (gout)

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7
Q

What are 3 main factors that may lead to RA?

A

genetics, environment, intrasynovial immune response

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8
Q

Are there any signs and symptoms during phase 1 of RA?

A

No

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9
Q

What are signs and Sx during pre-clinical stage (phase 2)?

A

arthalgias, fatigue, mild morning stiffness, positive blood test

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10
Q

What are signs and Sx during clinical stage (phase 3) of RA?

A

polyarthritis/synovitis, severe morning stiffness, elevated ESD/CRP levels

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11
Q

What environmental factors can lead to RA?

A

smoking, periodontitis, silica, pollution, breast feeding, hormones, Obesity, viruses/EBV, stress/PSTD

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12
Q

What things are protective against RA?

A

Vitamin D, Oily fish, Omega 3, alcohol, olive oil

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13
Q

What are the main characteristics of RA?

A

unpredictable, systemic inflammatory response (flu-like feeling), symmetric synovitis, progressive joint destruction/deformity

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14
Q

What are four areas of criteria for diagnosis of RA?

A
  1. joint distribution
  2. serology
  3. symptom duration
  4. acute phase reactants (ESD/CRP)
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15
Q

What does your score for these criteria need to be over for definite RA?

A

greater or equal to 6

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16
Q

What is the definition of joint involvement?

A

any swollen or tender joint (excluding DIP of hands and feet, 1st MTP, 1st CMC)

may be confirmed by US or MRI

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17
Q

What are the four classes of fnx level of RA?

A

1- able to perform ADL
2- performs self care and vocational activities but limited in avocational
3- able to perform self care only
4- limited in all areas

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18
Q

What are the systemic features of RA?

A

fever, malaise, weakness, fever, weight loss

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19
Q

If an area on a pt’s hand is warm what does this mean?

A

could be RA, infection = hot

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20
Q

What is the involvement of hand and wrists with RA pts?

A

affected in 90% of cases

rotary subluxation, ulnar drift of MCP, Swan neck (flexed DIP) and Boutonniere’s(extended DIP) (both specific to RA)

symmetric but may be different on each side

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21
Q

What is the C-spine involvement for RA pts?

A

50% of patients experience c1-c2 involvement

50-70% AA subluxation

20-25% subaxial–death

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22
Q

Signs and Sx of c-spine involvement with RA?

A

occipital headaches, neck pain, parathesias in UE, vertigo, visual disturbences

always check this with RA pts

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23
Q

What changes involve the foot in patients with RA?

A

pronation, bunion, loss of fat pads, tendocalcaneal bursae

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24
Q

What is a extra-articular rheumatoid nodules?

A

tissues in hands or in lungs that increases friction

seen in 15-40% of pts

associated with low dose of MTX

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25
Q

What are cardiac complications in pts with RA?

A

more prevalent in RA, same risk as in diabetes

usually asymptomatic but important to be aware of when exercising pts
ex)mitral valve collapse (arrthymia)

26
Q

What is the purpose of lab test for pts with RA?

A

can find non-specific markers of inflammation, identify diagnosis, categorize disease process, monitor toxicity of meds

need to combine with history and symptoms, never alone

27
Q

What are frequent lab findings in pts with RA?

A

RBC down, ESR up, RF positive

28
Q

Which marker is a stronger indicator of RA, CRP or ESD?

A

CRP, not affected by anemia and more stable protein

29
Q

What percentage of RA patients are RF positive?

A

60-75%

30
Q

What HLA type is present in RA?

A

HLA-DR4 increased with RA pts

31
Q

What is the DAS-CRP 3?

A

mix of CRP and number of joint involvement

below 2.4 mild
2.4-3.7- moderate
above 3.7 highly active disease

32
Q

What were the early medical treatments of RA?

A

aspirin (needed a high dose) and steroids (crushed organs)

33
Q

What is more recent pharmacological treatment?

A

NSAIDS
DMARDS-gold stanard (MTX, corticosteroids)
Biologics (if dmards fail)

34
Q

What are the rehab goals for pts with RA?

A

maximize: strength, flexibility, endurance, mobility, pt independence

find baseline and go from there—return to sport? ADL’s?

35
Q

What factors do you have to consider during rehab?

A

fatigue- diff from regular fatigue from exercise, decreased aerobic capacity, multifactoral

pharmacological effects- some work fast, some work slow

36
Q

What is the main objective with patients with RA?

A

always try to stay active!

37
Q

What is whole body rest for RA pts?

A

offset fatigue and pathological stress

8-10 hours of sleep per night
30-60 mins during day

38
Q

What is POC with RA during acute inflammation?

A

rests, splints, modalities, isometrics, ROM, keep active

39
Q

What is POC with RA during subacute inflammation?

A

dynamic and ROM exercises, ergonomics, physical activity

40
Q

What is POC with RA during inactive/chronic inflammation?

A

aerobic exercises, work, accommodations, physical activity

41
Q

What are the three types of lupus?

A
  1. discoid
  2. drug induced
  3. systemic lupus erythematosous
42
Q

What is the epidemiology of SLE?

A

peak incidence-women in child bearing ages

9:1 female to male

1/2000 US pop.

2-3 more times frequent in Hispanics, African americans, Asains

43
Q

What is etiology of SLE?

A

autoimmune, cause unkown

  1. environmental factors
  2. genetic
  3. hormonal
44
Q

What environmental factors may cause SLE?

A 
UV light (pt feels worse in sunlight)
infectious agents- EBV (viral trigger?)
diet
hormones( b/c of high female prevalence)
growing up near industry
45
Q

What genetic factors could cause SLE?

A

5-12% of pts relative have SLE, family members have other autoimmune diseases, family members have high ANAs

46
Q

What are clinical manifestations of SLE?

A

plueral effusions, butterfly rash, heart problems, lupus nephritis(particular to SLE), arthritis, Raynaud’s

47
Q

What is ACR criteria for SLE?

A

malar rash, discoid rash (above eyes), photosensitivity, oral ulcers, hair loss arthritis, renal disorder, neurological signs, hematologic disorders, immunological

need four or more

48
Q

What percentage of SLE pts will have anemia?

A

40% due to iron deficiency, GI bleeds, auto antibody to RBC

49
Q

What other blood disorders do SLE tend to have?

A

leukopenia- 15-20%

thrombocytopenia- 25-35%

50
Q

What is anti- Ro and Anti- La associated with?

A

both with neonatal SLE

anti-Ro with photosensitivity

51
Q

What are main causes of early and late death in pts with SLE?

A

early: nephritis, infections, vasculitis
late: CAD

52
Q

What are SLE specific risk factors for cardiac disease?

A
  1. steroids (increase HTN)
  2. anti- dsDNA antibodies
  3. antiphospholipid antibodies
  4. other immune mechanisms
53
Q

What is focal glomerulonephritis?

A

local swelling of the kidney due to SLE

54
Q

What is advanced sclerosing glomerulonephritis?

A

scaring of the kidney due to SLE

55
Q

What is neuropsychiatric lupus?

A

clinical syndromes that affect the brain, spinal cord or nerves to the arms and legs

56
Q

What is the prevalence of neuro SLE in pts with lupus

A

25-75%

57
Q

What symptoms of Neuro SLE?

A

seizures, strokes, psychosis, neuropathy, mvmt disorders

58
Q

What are mental dysfunctions of neuro SLE?

A

attention, reasoning, executive skills, memory, language, visual spacing

59
Q

What is the pharmacological intervention for SLE?

A

minimize use of corticosteroids, and take cyclophosphamides for kindeys

60
Q

What are the general interventions for SLE pts?

A

education, rest, sunscreen, diet, exercise, immunizations, contraceptives

61
Q

What are PT considerations for patients with SLE?

A

pts may at high risk for DVT after TJR, be aware of signs and symptoms

asymptomatic CAD (squeeze back of calf to check), potential for avascular necrosis

kidney disease can lead to HTN

Pathology Exam 2 (4 decks)

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