14. Rheumatoid Arthritis Flashcards
Definition
Rheuma: Watery, not in OA. Primarily a disease of the synovium.
Epidemiology
Onset: Between 35 and 65.
3 times more prevalent in woman than men, autoimmune disorder?
Low incidence in indigenous pop.
Aetiology
No known cause, no cure. progressive life long. Flareups and remission.
Autoimmune disease.
Risk factors
Genetic predisposition, gender, smoking, family history, increased weight, toxins repetitive use of injured joint.
What happens?
Immune system attacks the lining or synovium of the joint. White blood cells move from blood stem and invade synovium, small blood vessels grow into the tissue. Synovial membrane become thick and inflamed and releases chemical which damage joint cartilage, joint capsule and ligaments.
What does an increase in ESR mean?
Suggests a strong inflammation process.
Signs and symptoms:
Joints of body become swollen and painful, fatigue, tiredness, stiffness in joints and muscular pains.
Changes line of pull of muscles via. the tendons. Also anaemia and inflammation of heart and lungs.
Tenosynovitis: Affects joints and tendons of hands, wrists, knees and feet
Is it symmetrical polyarthritis?
Yes, usually affects same joints on both sides of the body.
Symptoms of the joints:
Permanent changes in the shape and alignment of joints causing joint deformities.
Affects mostly: MCP, wrist IPS, and MTP
What is a boutonniere deformity?
Tendon rupture and slippage. When inflammation affects joint structure and alignment of tendons, pulling joints in different direction. Causes ulnar drift.
Typical deformity: Ulnar deviation.
Diagnosis:
No single test. Test for RF but on 80% have it, also Antti-ccp.
Clinical assessment laboratory tests and X-rays.
Also guidelines for diagnosis: Joint stiffness in morning, tendered and swelling of there or more joints.
Also X-rays.
Trajectory: What are the 3 cycles
Monocyclic: Complete remission within two years. one-off episode of condition.
Polycyclic: Progresses slowly with episodes of acute symptoms or flare-ups and remissions. Causes destruction at each flare up. Most common.
Progressive: Constant and progressive symptoms. Severe deformity of joints. Lots of pain and loss of function.
Co-occurring conditions:
Risk of developing type 2 diabetes, CVD, hypertension, osteoporosis, high cholesterol, depression, anaemia.
Treatment:
Early diagnosis and treatment.
To boost immune system but can cause it to become too active and attack bones even more.
Specialist management by rheumatologist.
Slow progression of disease, slow any deformity, splints.
