Rheumatoid Arthritis Flashcards Preview

MSK 2 Post Midterm > Rheumatoid Arthritis > Flashcards

Flashcards in Rheumatoid Arthritis Deck (29):
1

What type of disease is RA?

What does it target?

• Autoimmune, chronic systemic
• Inflammatory disease, symmetrical
• Targets synovial tissues, diarthrodial joints
• Polyarthritis, extra-articular features
• Idiopathic

2

Systemic features of RA
-systemic sx
-non specific labs
-constitutional sx

• Fatigue, fever, anemia
• Elevated acute phase reactants (ESR, CRP)
• Constitutional symptoms – malaise, myalgia,
depression
• Affected joints are swollen, warm and tender over PIP and MCP joints

3

Immunopathology/pathogenesis of RA (two)

• RF produced by RA synovium. RF’s fix complement. Complement consumed in RA joint; recruit PMN’s.
• Anti-cyclic citrullinated peptides

4

“B” lymphocytes produce autoantibodies, cytokines (TNF alpha, IL-1, IL6), pro-inflammatory cytokines synovial proliferation, increase synovial fluid, leads to ___ that invades cartilage and bone.

leads to pannus in RA

5

Lab tests to order for RA dx

• ESR/CRP
• RF
• ACCP
• ANA
• Hepatitis panel
• CBC

6

What two imaging tests should be ordered in RA - to detect what?

EROSION DETECTION!
• X-rays of hands and feet – detect symmetrical involvement of MCP/MTP joints; erosions
• CT – more sensitive detecting erosions

7

4 treatment progressions of RA

• Begin NSAID for pain control
• Early use of DMARD
• May need low dose of steroid for a few weeks
• Monitor progress and toxicity

8

Three types of Rheumatoid Synovitis

Bursitis, tendinitis, synovitis

9

Significant cause of mortality in RA

! Heart disease (60%) - CAD, HF, pericarditis due to endothelial damage from chronic inflammation !
-Malignancy (20%)
-Infection (9.4%)
-Renal disease (7.8%)
-GI disease (4%)

10

Who should be tested for RA? Classification criteria

What is definite RA?

1. Have at least one (1) joint with definite clinical synovitis
2. With synovitis not better explained by another disease

A score > 6/10 = definite RA

Serology + APR + Duration of Symptoms

11

Describe articular manifestations of RA.

-Typically starts in hands/feet (MCP, PIP, MTP)
-Later = larger joints, wrists, knees, elbows, ankles, hips, shoulders

12

Part of spine that is affected by RA

C1-C2

13

define swan neck and boutonniere

• Swan neck (hyperextension of PIP joints)
• Boutonniere (button hole
deformity) (hyperflexion of PIP joints)

14

Rheumatoid nodules = RF+/-?

RF+ always

15

Baker cysts

RF nodules in knee/popliteal

16

**Describe clinical manifestations of RA - describe the PE of joints, what type of joints, what time of day? Is this abrupt or insidious?

• Pain, swelling, warmth in multiple small joints (less than 3) of hands and/or feet
• Morning stiffness greater than one (1) year
• Less than 10% have abrupt onset of disease

17

**Dx of RA is active signs of inflammation for at least __ weeks.

six

18

**Extra-Articular Manifestations of RA

-more common in what type of RA patient
-what are the manifestations?

• More common in RF positive or Anti-CCP positive
• Skin – subcutaneous nodules; extensor surface of forearm

19

What is this:
Tender reddish purple papule; leads to necrotic, non-healing ulcer

pyoderm gangrenosum

20

What is this:
Purpura, petechial, splinter hemorrhages, digital infarct

Rheumatoid vasculitis

21

What is RA + pneumoconiosis + pulm nodules?
CXR hyperlucency.

What is it due to?

Felty Syndrome. Nodular densities after exposure to coal or silica dust.

22

What is keratoconjuctivitis sicca?

Extra-articular manifestation of RA due to a secondary Sjogrens Syndrome or SLE (Dry eyes)
- dry eyes, damage to eye surface
- dry mouth, increased tooth decay

23

Tests for Sjogrens

• Ro/SS-a, La/SS-B (both associated with salivary gland involvement)
• Schirmers test (tear test)
• Slit-lamp exam

24

Tx for Sjogren's Syndrome

Anti – Inflammatory &
Immunosuppressive

25

What is:
• RA
• Splenomegalia
• Neutropenia/anemia/thrombocytopenia

Feltys Syndrome

26

While there is NO SINGLE finding on PE or lab that is pathogneumonic, describe lab findings in RA

• RF positive
• Anti-CCP antibody (remember – 15%-20% of RA patients are negative for these antibodies)
• Inc. ESR or CRP parallels activity of disease
• Anemia (NC-NC, chronic)
• Thrombocytosis (acute phase reactant)
• ANA+ (30% of RA patients)
• Hyperglobulinemia
• Leukopenia / Granulocytopenia
• Low glucose in body fluids
• Synovial fluid – 2/3 PMN’s; WBC’s 5000 – 100,000/mm3

27

Tx of RA
Non-biologic DMARDs
Biologic DMARDs
(which can be used in pregnancy?)

No cure - treat early and to keep in remission; PT/OT

DMARD + bridging therapy (NSAIDs, then CS)

Non-biologic DMARDs:
**PREG? YES, then use **antimalarial (hydrochlorquine) and sulfasalazine
**PREG? NO, then use MTX, leflunomide (pyrimidine antag)

Biologic DMARDs:
(immunosuppressants etanercept, infliximab, adalimumab, rituximab)

-ANALGESICS are necessary to control pain

28

**Define progression of RA management

• Define extent of joint and extra-articular involvement
• Full dose of NSAID
• Early use of DMARD
• Add a biologic agent
• Low does steroids – flares/bridge
• Adequate pain management
• Monitor progress/toxicity

29

RA is MC secondary cause of what?

Sjogren's (anti-SSA/B, speckled)