Rheumatoid Arthritis

Question 1

Onset of RA?

Answer 1

35-50 years

Question 2

Higher prevalence in _______ population

Answer 2

aboriginal

Question 3

RA is an _______ disease

Answer 3

autoimmune

Question 4

In response to immunologic factors, ______ ______ become inflamed

Answer 4

synovial membranes

Question 5

Synovial cell proliferation = ______

Answer 5

hyperplasia

Question 6

First thing that happens in RA?

Answer 6

Synovitis

Question 7

Increased __________ brings in a lot of inflammatory cells

Answer 7

vascularity

Question 8

Articular damage is caused by _____

Answer 8

pannus

Question 9

Pannus = _______ tissue formed within synovium

Answer 9

granulation

Question 10

Inflammatory mediators such as ____ and ___ can cause joint damage

Answer 10

IL-6; TNF

Question 11

Bone _____ can be effected if inflammation is not controlled

Answer 11

density (OP)

Question 12

The pannus spreads over the articular cartilage and erodes the underlying _____ and _____.

Answer 12

cartilage; bone

Question 13

Pannus may extend over time to the opposite articular surface creating _____ _____, _______ and ______.

Answer 13

scar tissue; adhesions; ankylosis

Question 14

Bone becomes _____, ligaments and tendons are damaged or ruptured, and surrounding muscular _______ leaving the joints unstable and prone to _______.

Answer 14

osteopenic; deteriorate; deformity

Question 15

Synovial cells become more _____ in the pannus.

Answer 15

fibrous

Question 16

______ occurs at the end stage of the disease.

Answer 16

ankylosis

Question 17

Familial hx of RA = overall increased risk by __x.

Answer 17

2x

Question 18

RF is a genetic marker present in ___% of people with RA

Answer 18

80

Question 19

RF accounts for about __% of the genetic risk for RA

Answer 19

30

Question 20

There is elevated RF in __-__% of healthy persons > 60 yo.

Answer 20

5-10

Question 21

High RF count cannot be used as a dx for RA as many other diseases can also have a high RF count. Name 4?

Answer 21

1. lupus
2. syphilis
3. chronic hepatitis
4. IPF

Question 22

________ _______ = RF -ve and with clinical symptoms of RA

Answer 22

seronegative arthritis

Question 23

Seronegative arthritis found in __% of patients

Answer 23

30

Question 24

Increased risk of RA after ____ _____

Answer 24

child birth

Question 25

Increased risk of RA after childbirth may be due to increased ______.

Answer 25

prolactin

Question 26

Cigarette smoking ____ the risk of RA, esp. in (men/women)

Answer 26

increases; men

Question 27

In terms of diet, decreased risk with consumption of what 3 things?

Answer 27

1. olive oil 2. fish (> 3 x per week) 3. drinking tea (> 3 cups/day)

Question 28

A dx of RA is made when >/= __/7 criteria are met

Answer 28

4

Question 29

What are the 7 criteria for RA?

Answer 29

1. morning stiffness > 1 hour (>/=6 weeks) 2. arthritis of >/= 3 joints ((>/=6 weeks) 3. arthritis of hand joints (>/=6 weeks) 4. symmetric arthritis (>/=6 weeks) 5. rheumatoid nodules 6. serum rheumatoid factor + 7. radiographic changes

Question 30

RA often spares the ___ joint

Answer 30

DIP

Question 31

What are 10 clinical features of RA?

Answer 31

1. pain 2. stiffness 3. fatigue 4. decreased ROM 5. often involves small joints 6. often symmetrical 7. swelling 8. joint deformity 9. mm atrophy 10. extraarticular features

Question 32

________ use in individuals with RA can increase muscle atrophy.

Answer 32

corticosteroid

Question 33

Nodules develop _______

Answer 33

subcutaneously

Question 34

Nodules are occasionally found in ___ and ___ tissues, which = poorer prognosis

Answer 34

heart; lung

Question 35

Rheumatoid nodules affects about ___% of patients at some point during the disease

Answer 35

30

Question 36

Rheumatoid nodules occur (earlier/later) in the disease progress

Answer 36

later

Question 37

Where are rheumatoid nodules typically found ?

Answer 37

elbow, fingers, wrist and hip joint, lower back, achilles tendon

Question 38

Secondary Raynaud's phenomenon is prevalent in __% of RA pt's

Answer 38

17

Question 39

Secondary Raynaud's phenomenon caused by _______ in capillaries when exposed to cold or stress

Answer 39

vasospasm

Question 40

4 management strategies in RA?

Answer 40

1. meds 2. rehab intereventions 3. lifestyle modification / self-management 4. sx

Question 41

2 drugs that halt the disease process?

Answer 41

1. traditional DMARD (disease modifying anti-rheumatic drugs) 2. biologic DMARD

Question 42

Most powerful fast acting anti-inflammatory ?

Answer 42

corticosteroid

Question 43

First line rx in RA?

Answer 43

DMARD

Question 44

DMARD should be used early and consistently to prevent ________ joint damage.

Answer 44

irreversible

Question 45

Example of a DMARD?

Answer 45

methotrexate

Question 46

What is the rehab goal in the acute phase of RA?

Answer 46

control/decrease inflammation, control pain

Question 47

Do not stretch an acutely inflamed joint because the _____ ______ is already distended

Answer 47

synovial membrane

Question 48

4 rehab interventions in the acute?

Answer 48

1. balance rest and activity - energy conservation 2. ice 3. splints, positioning 4. ROM exercises

Question 49

5 rehab goals in the chronic phase?

Answer 49

1. improve knowledge about RA and active self-management 2. improve pain and stiffness 3. improve function and activity level 4. prevent deformity 5. address muscle imbalance

Question 50

4 rehab interventions to improve pain and stiffness in chronic phase?

Answer 50

1. modalities 2. positioning, supports, splints 3. exercise - ROM, gentle strengthening 4. energy conservation

Question 51

____ prevention education is important in the chronic phase

Answer 51

falls

Question 52

Those with RA should avoid a _____ lifestyle

Answer 52

sedentary

Question 53

3 skills needed for self-management of RA?

Answer 53

1. problem-solving 2. self-monitoring 3. communication

Question 54

4 R's in sx management of RA?

Answer 54

1. Remove 2. Re-align 3. Rest 4. Replace

Question 55

Remove in terms of sx management?

Answer 55

synovectomy, MTP resection

Question 56

Re-align in terms of sx management?

Answer 56

tendon rupture repairs

Question 57

Rest in terms of sx management?

Answer 57

arthrodesis of the ankle, wrist, C1-C2

Question 58

Replace in terms of sx management?

Answer 58

arthroplasty hip, knee, ankle, shoulder, MCP joints

Question 59

Decreasing ____ and ____ are the most important goals from the patents perspective

Answer 59

pain; fatigue