2. Rheumatoid Foot (Van) Flashcards
list seropositive and seronegative conditions
- seroPOSITIVE: Rheumatoid Arthritis
- seroNEGATIVE
- psoriatic arthritis
- Reiter’s syndrome (reactive arthritis)
- ankylosing spondylitis
- enteropathic spondylitis (assoc w/ Crohn’s/ UC)
how often is bunion deformity (HAV) seen in RA patients?
in 59-90% of patients
describe joint involvement with Rheumatoid Arthritis
- Chronic,
- systemic,
- bilateral,
- symmetrical joint involvement (chronic proliferative synovitis, “cancer of the synovium tissue”)
epidemiology of RA
Female, 35-45 y/o, likely w/ HLA-DRG Ag
- F>M, F:M 4-5:1
- (peak onset 35-45 years),
- HLA-DR4 antigen increases risks by 5X
which lab can you use to definitively define RA?
- NO ONE DEFINITIVE TEST DETERMINES IF YOU HAVE RA → multiple labs collectively being positive gives you a higher likelihood if being positive
-
RF, ESR, CRP, ANA, anti-CCP (cyclic citrullinated peptide)
- ESR/CRP – inflammation markers, increased in infection/OM
what are the (7) seven RA criteria?
- morning stiffness
- arthritis of hand joints
- arthritis of 3+ joints
- symmetric arthritis
- rheumatoid nodules
- serum RF (rheumatoid factor)
- radiographic changes
how many of the 7 RA criteria need to be positive to be diagnosed?
need 4 out of 7 criteria to be diagnosied
articular manifestations of RA
- joint swelling/tenderness,
- local warmth,
- limited ROM,
- symmetrical joint involvement,
- deformities (swan neck, Boutonniere, HAV, hammertoes, fibular deviation of digits)
Extra-articular manifestations of RA:
- CV: percarditis
- Resp: pleurisy, diffuse interstitial lung disease, nodules, Caplin’s syndrome (nodes of lungs)
-
Skin:
- rheumatoid nodules (typically over pressure points, e.g. knuckles),
- vasculitis (leukocytoclastic angiitis, nail fold infarcts, _splinter hemorrhages_)
describe the pathology of joint destruction in RA
- Up-regulation of endothelial adhesion molecules and leukocyte migration into proliferative synovial tissue
- Synovium becomes hypertrophic
- Granulation tissue extends to cartilage → pannus
- Diseased synovium releases proteases and collagenases –> destroy articular cartilage and bone
define:
pannus
abnormal layer of fibrovascular tissue or granulation tissue;
often seen over a joint surface in RA; can also form on cornea or on prosthetic heart valve
key characteristics of RA gait
- Painful propulsion – HAV and hammertoes
- Painful heel strike – retrocalcaneal bursitis, etc
- Slower gait/shorter step length/larger unstable stance phase – everted heel with prolonged STJ pronation
- Body weight transferred posteriorly – late heel rise
pre-op imaging may show what characteristics, suggesting RA?
- X-rays – periosteal reaction, cortical thinning, osteoporosis, sclerosis, osteophyte formation, defects, cystic changes, surface erosion, joint space narrowing and ankylosis
-
MRI (gadolinium) – gold standard for early detection of RA changes → BONE MARROW EDEMA
- SYNOVITIS (synovitis equals active inflammatory arthritis)
- Classical cuts: coronal, sagittal, axial
- “I rarely order MRI for RA patients because treatment is still the same”
- US – real-time visualization
gold standard for early detection of RA changes on imaging?
MRI (gadolinium) –> showing BONE MARROW EDEMA
define:
synovitis
-
inflammation of the synovial membrane
- This membrane lines joints that possess cavities, known as synovial joints
- Sxs
- The condition is usually painful, particularly when the joint is moved
- The joint usually swells due to synovial fluid collection
