Rheumatology - Rheumatoid Arthritis Flashcards
What are the risk factors for rheumatoid arthritis?
Women
Middle age
Smoking
Obesity
HLADR4 gene
What antibodies are present in RA?
Rheumatoid factor
Anti-CCP
Where does the rheumatoid factor autoantibody target?
Fc portion of IgG
Causes immune activation against IgG
Most often IgM
What antibody is more specific and sensitive?
Anti-CCP
Often present before patient affected by RA
How does RA present?
Pain
Stiffness
Swelling
Symmetrical distal polyarthritis
What joints are most affected in RA?
MCP
PIPs
Wrist
MTP
What is present on palpation of joints affected by RA?
Tenderness
Synovial thickening
Boggy feeling
What are the hand signs in RA?
Z-shaped deformity
Swan neck deformity
Boutonniere deformity
Ulnar deviation
What causes boutonniere deformity?
Tear in central slip of extensor components at PIP
Central slip connects middle phalanx to PIP
Lateral bands go around PIP and connect to distal phalanx
Hyperextension of DIP
Flexion of PIP
What causes swan neck deformity?
Tear of central slip in flexor
Hyperflexion of DIP
Extension of PIP
What are some extra-articular manifestations of RA?
Episcleritis
Keratitis
Cataracts
Retinopathy
Felty’s syndrome
Anaemia of chronic disease
Carpal tunnel syndrome
What is atlantoaxial subluxation?
Synovitis and damage to ligaments around the peg
Can cause spinal cord compression
MRI
How is RA diagnosed?
RF
Anti-CCP
CRP and ESR
X-rays
USS or MRI to detect synovitis
What are the x-ray changes of RA?
Periarticular osteopenia
Boney erosions
Soft tissue swelling
Joint destruction and deformity
What scoring systems are used for RA?
HAQ
Disease Activity Score 28 joints
