Rheumatoid Arthritis (RA)

Question 1

What is RA?

Answer 1

A chronic inflammatory disorder that may affect many tissues and organs.

Auto-immune disorder= It mainly attacks the joints producing an inflammatory synovitis

• A chronic disease who’s pain intensity and deterioration of joint structures progress over time often leading to deformations and disability

Question 2

Epidemiology of RA?

Answer 2

• Affects -.5 to 1% of the population world wide
• Women 3x more than men ( pre menopause)
• More common in smokers
• Family history plays a role
• Genetic factors*
• Most commonly diagnosed between the ages of 40 and 50 years and no later than 80 years of age.
• Peak prevalence 30 to 50 years

Question 3

Clinical features of RA

Answer 3

• Onset of pain
• Early morning stiffness (>30 min)
• Swelling in the small joints of the hands and feet
• rheumatoid nodule
• As disease progresses there is weakening of joint capsules
• • joint instability
• • subluxation (partial dislocation)
• • deformity

Question 3

What are the possible hand deformities resulting from RA

Answer 3

1. Trigger fingers= finger gets stuck in a flexed position and then snaps straight
2.  Boutonniere deformity= * middle PIP becomes stuck in a bent position and the MCP and DIP hyperextend
3. Swan Neck = MCP and DIP abnormally flex and PIP hyperextends
4.  Hitchhikers thumb= MCP abnormally flexes while IP hyperextends
5. • Ulnar deviation = MCP dislocate towards ulnar side

Question 3

complications associated with RA?

Answer 3

• ruptured tendons
• ruptured joints (bakers cysts)
• joint infections

Question 4

Signs and symptoms of RA?

Answer 4

• Arthritis of the joints – synovitis
• Joints become swollen, tender and warm and stiffness limits their movement
• Affects Multiple joints often small joints such as hands and feet. And larger joints such as the shoulder and knees.
• Synovitis can lead to tethering of tissue with loss of movement and erosion of the joint surface causing deformity and loss of function.
• Often symmetrical but initially can be asymmetrical

Question 5

Diagnosis of RA?

Answer 5

Must at least meet 4 of these criteria’s:

• morning stiffness >1 hour most mornings > 6 weeks
• • arthritis and soft tissue swelling >3 of 14 joints > 6 weeks
• • arthritis of the hand joints > 6 weeks
• • symmetric arthritis > 6 weeks
• • subcutaneous nodules in specific places
• • Rheumatoid factor at a level above the 95% percentile
• • Radiological changes suggestive of joint erosion (erosions , periarticular osteopenia)

Question 6

Management of RA?

Answer 6

here are no treatment cures for RA

Goal is to alleviate the current symptoms and to prevent future destruction of the joints resulting in handicap.

• drug therapy; cortisone, anti-inflammatory agents
• weight loss
• physio
• OT
• acupuncture