Rheumatoid Athritis Flashcards
(36 cards)
Pt population where rheumatoid arthritis is common seen in
Women (3x men) ages 40-50
Native Americans (5x higher)
Smokers (4x nonsmoker)
What area of the body does Rheumatoid Arthritis (RA) spares?
Lower back
Pathophysiology of RA
- Genetic factor (HLA-DRB shared epitope)
- Synovial membrane becomes hyperplastic –> immune and inflammatory cells –> synovitis
- increase lvl of cytokines
- APC, B cells, MHC, CD4+ T cells play a role
Does RA commonly affect 1 single joint or multiple joints?
Multiple joints
Which joints do RA commonly Affect?
Small joints of hands (PIP joints), DIP spared Feet CERVICAL SPINE (not lower back) Larger joints (shoulder and knees)
How does synovitis present?
Joints become swollen, tender, warm and stiff which causes limited movement
Are joints affected in a symmetrical or asymmetrical pattern?
Symmetrical
Where are rheumatoid nodules commonly located?
Bony prominences
- olceranon
- calcaneal tuberosity
- MCP joints in hands
Which organs is usually not affected by RA?
A. Heart B. Lung C. Kidney D. Eyes E. Blood
C. KIDNEY
RA commonly affects:
- Lungs–fibrous CT
- Eyes–keratoconjunctivitis sicca
- Skin–rheumatoid nodules
- Heart–pericardial effusion
- Nervous sytem–cervical spine instability (C1-C2)
- Blood–hypochromatic microcytic anemia w/ low serum ferritin or normal ferritin
What are some cardiac complications caused by RA?
MI Disambiguation Stroke Atherosclerosis Pericarditis Endocarditis LV HF Vaculitis
What are some Physcial Exam findings of RA
- warm tender erythematous joints (hand and wrist)
- DIP excluded
- Ulnar deviation of digits
- Boutonniere’s deformity
- Rheumatoid nodule
- Baker cyst in popliteal space
What is the most specific lab finding that is suggestive of RA?
Anti-cyclic citrullinated peptide antibody (ACCPA)
-Rheumatoid factor can be falsely negative
What is the MAINSTAY tx of RA
METHOTREXATE (w/ or w/o biologic agent)
What else should a pt be on when initiated methotraxate for RA?
Corticosteroid (prednisone)
MTX +/-DMARD takes awhile to take effect
Will NSAIDs alter the disease progression of RA?
NO. only used for pain relief
What are DMARDs?
Dz modifying anti-rhuematoid drugs
What is Felty’s Syndrome
RA + Neutropenia + Splenomegaly
What cervical complication can be seen in RA?
Atlanto-axial subluxation
-caution cervical motion, avoid chiroparactors, can develop hand and foot paresthesia and paraplegia
Does RA most commonly afffect the PIP or DIP joint?
PIP joint
SPARED DIP joint
What does polymyalgia rheumatic (PMR) mainly affect?
Proximal muscles (upper arms, thighs, hip girdle and shoulders)
Pathophys of PMR
idiopathic inflammatory disorder of pain mainly assoc w/ proximal muscles
Also assoc w/ temporal arteritis
Presentation of PMR
-abrupt onset and self lmiting
-PAIN not weakness
-worse in AM
-general aches, pain and stiffness
“trouble getting dressed”
What pt population is most common affected by PMR?
Elderly >50yo
Tx of PMR
PREDNISONE
