3 - Arthritis Flashcards
MC inflammatory arthritis?
Rheumatoid arthritis
MC pt population for RA?
Females 30-40’s
Males 50-70’s
Define RA
Chronic systemic inflammatory disease of UKN cause,
- primarily targets the synovium
- Leading to loss of articular cartilage and erosion of juxta-articular bone
Causes of RA?
Direct synovial infection :
- mycoplasma
- parvovirus
- retroviruses
Molecular mimickry of QKRAA
Enteric bacterial infections
- mycobacterial spp
- EBV
Strongest association to RA?
HLA-DRB1
“Shared epitope”
Presentation of RA?
Insidious, chronic, symmetric arthritis of:
- small joints
- hands and writsts
Start in:
- PIP
- MCP
- MTP
Which joints are usually affected w RA
MCP, PIP, and MTP»_space; Wrist, knee, elbow, ankles, hip, shoulders
Joints spared by RA?
DIPs
T/L spine
Late joint deformities for RA?
Ulnar deviation of MCP
Boutonnier deformity
Swan-neck deformity
With RA pts you must be careful?
With intubation
Risk of spinal injury with C1-C2
What should be checked with RA joints?
Joint effusions - synovial fluid analysis
Extra articular manifestations of RA?
Rheumatoid nodules
Episcleritis
Pleural effusions
Differenting from Sjogren’s sydrome?
RA is anti-Ro/Anti-La neg
Specific RA tests?
RF
Anti-CCP antibodies
T, B, complement cells?
RA has an activation of T cells, B cells and complement within the synovium
Labs for RA?
RF ESR/CRP CBC Anti-CCP ANA Chem/LFT Anemia THrombocytosis
Synovial fluid with RA?
WBC 5k-50k
- 75% neutrophils
Radiology for RA?
Juxta-articular erosions and joint-space narrowing
PE for RA
Synovitis
Nodules
Splenomegaly
RA non-pharm therapies?
Education Exercise Rest Wt loss PT/OT Orthotic devices (splints)
Pharmacologic therapies for RA?
NSAIDS Glucocorticoids - DMARD bridge Synthetic DMARD Biologic DMARD
Standard of care for RA?
Methotrexate + folic acid
Synthetic DMARDs for RA?
Methotrexate + folic acid Lefluonomide Sulfasalazine (combo tx) Hydroxychloroquine Minocycline (<2yrs only)
Least effective synthetic DMARD?
Hydroxychloroquine
- least effective
- renal toxicity
Biologic DMARDs problems?
Effective but more expensive
Increased risk for:
- TB
- Hep B/C
- lymphoma
Biologic DMARDS?
TNF-alpha inhibitiors
- infliximab (remicade)
- entanercept (enbrel)
- adalimumab (humira)
- golimumab (simponi)
- certolizumab (cimzia)
Selective constimulation modifier
- abatacept (orencia)
Interlukin-1 receptor aganost
- anakinra
Monoclonial antibody
- rituximab (rituxin)
- tocilizumab (actemra)
MC form of childhood arthritis?
Juvenile idiopathat arthritis
JIA
Subgroups of JIA?
- Systemic
- Polyarticular (sero+/-)
- Oligoarticualr
- Psoriatic (not discussed)
- Enthesitis-related (not discussed)
IOT be JIA pt must have?
> /= 6 weeks of persistent joint swelling
Excludes other types of childhood arthritis
S/s of JIA?
> /= 6 weeks of joint swelling
Systemic symptoms
- fevers
- fatigue
- pain
- appear acutely ill
Diagnostic criteria for JIA?
- Age <16
- Persistent joint swelling x 6 weeks
- Exclusion of other causes
What are the diagnostic lab criteria for JIA?
None are diagnostic but:
RF + <20%
ANA + 85%
Often see increase in:
- WBC
- ESR
- Ferritin
- CRP
- platelets
- abnormal LFTs
- Anemia
Treatment for JIA?
Think RA, its similar
REFERRAL
NSAIDS
Glucocorticoids (oral and IA)
DMARDS (methotrexate)
Who is prone to seropositive polyarticular arthritis?
Teenaged girls
Seropositive polyarthritis has ___ joints involved?
> /= 5 at onset
Seropositive polyarthritis has an ___ ___
Aggressive course
Describe the course of seropositive polyarticular
Aggressive
- Vasculitis
- Nodules
- Felty syndrome
- Lung disease
- Erosive joint disease
What disease does seropositive polyarticular mimic?
Resembles the adult form of:
- classic rheumatoid factor positive RA
Diagnostic criteria for seropositive polyarthicular arthritis?
Seropositive (+RF)
Tx for seropositive polyarticular arthritis
Referral
NSAIDS
Glucocorticoids (oral, IA)
DMARDs (methotrexate)
Seronegative polyarticular affects predominatly?
Girls = boys
8-12 y/o
Seronegative polyarticular s/s?
Poor wt gain/growth May/may not be: - symmetric - large joints - knees - ankles - wrists
When are radiographic changes seen with Seronegative polyarticular?
May be several years before erosive changes are seen before erosive changes are seen on radiographs
Diagnostic for Seronegative polyarticular?
Seronegative (-RF)
Seronegative polyarticular tx?
REFERRAL
NSAIDS
Glucocorticoids (oral or IA)
DMARDS (methotrexate)
What is the MC subgroup of JIA?
Oligoarticular
Patient population for Oligoarticular?
Girls 1-7 y/o
Diagnostic criteria for Oligoarticular?
<4 joint groups
If Oligoarticular progresses to more than 4 joints what happens?
< 6 mo - polyarticular arthritis
> 6 mo - extended oligoarticular
Oligoarticular pts complain of?
Morning stiffness
MC knees
Diagnostic blood work for Oligoarticular?
ANA +
ANA pos Oligoarticular pts are at a risk for?
Asymptomatic iritis
Get them to optho
Oligoarticular tx?
Same as JIA
REFERRAl
NSAIDS
Glucocorticoids (oral, IA)
DMARDS (methotrexate)
