Rheumatoid Arthritis Dx and Tx Flashcards
(29 cards)
What is the most common polyarthritis?
- Rheumatoid arthritis; RA (connective tissue disease)
What are the connective tissue disorders in order of most to least common?
- RA
- SLE
- systemic sclerosis
- poly/dermatomyositis
- vasculitis
- sjogren’s syndrome
- overlap (MCTD)
- undifferentiated CTD
What type of appearance will you see in the digits in a pt with RA?
- fusiform swelling and hyperpigmentation of the joints of the HANDS (mainly wrist, MCPs and PIPs) and FEET (MTPs and dorsum of foot).
What is RA?
- progressive, systemic, inflammatory disorder of unknown etiology.
- characterized by symmetric synovitis, joint erosions, and multisystem extra-articular manifestations.
Where does the pathogenesis begin in RA?
- in the lining of the joint SYNOVIUM
What is the genetic predisposition to develop RA?
- HLA-DR4 (chromosome 6)
Do more men or women get RA?
- women
What is the age of onset of RA?
20-45
What is the most common extra-articular manifestation of RA?
- anemia
What specific factor will you see on serology with RA?
- rheumatoid factor
What virus can mimic RA?
- Parvovirus B-19
* usually involving a school teacher
What should be on your DDx for RA?
- thyroid
- infection
- osteoarthritis
- gout
- seronegative spondylitis
- PMR
- rheumatic fever
Will pts with RA often have subcutaneous nodules?
- YES
What is Caplan’s syndrome?
- pneumoconiosis of the lungs with RA
When you’re sending your pt for a joint replacement with RA, what should you always do?
- do a cervical spine x ray to make sure there isn’t a C1/2 subluxation
What are the extra-articular manifestations of RA?
- anemia
- nodules
- lymphadenopathy
- pleural effusion with low glucose
- Raynaud’s
- Sjogren’s
- cardiac
What lab data will you see in RA?
- anemia (80%)
- Rheumatoid factor (85%)
- anti-CCP
- ANA
- elevation of ESR
- group II synovial fluid
- polyclonal gammopathy
What is rheumatoid factor?
- IgM directed against Fc portion of IgG.
What is anti-cyclic citrullinated peptide antibody (Anti-CCP)?
- citrullinated peptides, which are autoantigenic targets produced in synovial joints.
- detected by ELISA
What are the x-ray findings of RA?
- soft tissue swelling
- juxtaarticular osteopenia
- symmetrical (both sides of the joint) joint space narrowing
- erosions
When does the most significant damage occur to the joints in RA?
- in the initial 1-2 years of disease
* treat aggressively and early.
What are the goals of therapy?
- control disease activity
- alleviate pain
- maintain function for essential daily activities
- slow progression
What non-pharmacologic management is involved in RA?
- REST
- exercise (stretching, muscle conditioning)
- diet/weight control
What drugs do we use to treat RA?
- NSAIDs
2. DMARDs (hydroxychloroquine, methotrexate, leflunomide, sulfasalzaine, gold, penicillamine, TNF-alpha inhibitors).
