Rheumatoid Arthritis Day 1 Flashcards
(49 cards)
What is the epidemiology of RA?
Age onset :30-60
Women>men
Equal in racial groups
progressive
What are the theories that cause RA?
Genetic Susceptibility with HLA-DR4 Environment: -virus: Epstein Barr -Bacteria: Strep, staph, e. coli -chemical: silica, heavy metal, cigarette smoke Hormones: estrogen
What is the pathophysiology of RA?
Chronic infmamattion of synovial tissue (Pannus)
This leads to cartilage and bone erosion
What antibodies are present in RA?
RF is positive and generally is >1:320
ACPA positive is poor prognosis
What Cell mediated functions are present in RA?
APC’s present self antigen to T lymphocytes and there are more T- helpers in synovial tissuse
What pro inflammatory cytokines are produces?
TNF- alpha, IL-1 and IL-6
What vasoactive substance are active in RA and what do they do?
Histamine and Prostoglandins. They increase blood flow to the site causing edema, warmth, erythmia and pain
What is the Disease course for RA?
It varies but most often it is a progressive onset with uninterupted symptoms resulting in disabling joint deformities. 1/3 of patients have mild intermittent symptoms followed by periods of remission. uncommon is sudden onset with a prolonged remission. Causes death if CV disease, cancer and infection
What is the clinical presentaiton of RA?
joint muscle stiffness >6 weeks fatigue, weakness, fever morning stiffness that lasts hours decreased appetite joint pain with or without movement symmetrical joint pain increasing pain and stiffness warmth and swelling over affected joints Labs: RF, ACPA, ESR, CRP, CBC
What joints are involved in RA?
common- hands, wrist, feet
can be in elbows, shoulders, hips, knees and ankles
In RA, what is the articular manifestations in the hands?
Bilateral swelling of the MCP or PIP joints
Ulnar deviation of the fingers
swan neck/ boutonniere deformities
In RA, what is the articular manifestations in the shoulders?
limited Range of motion
tenderness
pain at night
In RA, what is the articular manifestations in the feet and ankles?
flattening of the feet hammer toes halllus valgus (bunion) calluses pressure sores
In RA, what is the articular manifestations in the knees?
loss of cartilage instability and joint pain popliteal or Baker's cycts muscle atropy abdominal gail
In RA, what is the articular manifestations in the hips?
limited range of motion and very painful on movement
In RA, what is the articular manifestations in the spine?
typically affects the 1st and 2nd vertebrae
neck pain on movement
occipital headache
neurologic involvement
In RA, what is the involvement of Ocular?
inflammation of sclera, episclera, and cornea
decreased tear formation
sjogren’s syndrome
In RA, what is the involvement of Pulmonary?
plueral effusions and pulmonary fibrosis
In RA, what is the involvement of Cardiac?
increased cardiovascular mortality
pericarditis
In RA, what is the involvement of Rheumatoid nodules?
on in 20% and commin with erosive disease
asymptomatic
In RA, what is the involvement of vasculitis?
in long standing RA and noticed around nail beds
In RA, what is the involvement of Spleen?
Felty’s syndrome
What are the Lab findings in RA?
anemia of chronic disease thrombocytopenia elevated ESR elevated CRP RF and Titer ACPA ANA synovial fluid analysis is turbid due to high # of leukocytes Radiologic changes
What is the Disease Prognosis of RA?
joint erosion within 2 years
damage seen in 4 months
decreased life expectancy by 5-7 years
20-50% go into remission
