3 - Rheumatoid arthritis Flashcards
What is rheumatoid arthritis?
- multi system disease
- disease of synovium with gradual inflammatory joint destruction
- symmetrical polyarthritis that affects mainly peripheral joints
- different pattern of disease and joint involvement depending if sero-positive/-negative
What is sero-positive rheumatoid arthritis?
Rheumatoid factor present
What is sero-negative rheumatoid arthritis?
Rheumatoid factor not present
What are the symptoms of RA?
- slow onset
- initially in hands and feet but can spread to all synovial structures
- symmetrical polyarthritis
- pain, morning stiffness, swelling and general joint stiffness common
- systemic symptoms included fatigue, fever, numbness and tingling, decreased range of movement
What are early signs of RA?
- symmetrical synovitis of MCP joints
- symmetrical synovitis of PIP joints
- symmetrical synovitis of wrist joints
What is synovitis?
- inflammation of the synovium
- swelling, stiffness and pain that eventually leads to destruction of joint
What are late signs of RA?
- deformation of hands, feet and ankles common
- ulnar deviation of fingers at MCP
- hyperextension of PIP joints (swan necking)
- “Z” deformity of thumb (hyperflexion of MCP and hyperextension of IP)
- subluxation of wrist
- loss of abduction and external rotation of shoulders
- flexion of elbows and knees
- loss of function including walking
What are the extra-articular features of RA?
- caused by systemic vasculitis
- psoriasis
- scleritis and episcleritis
- dry eyes, Sjögren’s syndrome
- subcutaneous nodules
- amyloidosis
- pulmonary inflammation
- neurological issues
What investigations can be done for RA?
Radiographs/CT/MRI
- look for erosion, loss of joint space, deformity
- joint destruction/secondary osteoarthritis
Blood
- normocytic, normochromic anaemia (failure of RBC stimulation)
How do you treat RA?
- holistic management
- aim to maintain current function
- combination of physiotherapy, OT, drug therapy and surgery
Describe physiotherapy used for RA.
- aim to keep patient as active as possible for as long as possible
- both active and passive exercises
- improve joint stability
- maintain joint position
- delay onset of debilitating disease
Describe occupational therapy used for RA.
- maximising residual function for those with limited manual ability
- provide aids for independent living
- assessment and alteration of home to maintain independence (chair lift, wet room etc)
Describe the drug therapy used in RA.
- analgesics (paracetamol, cocodamol)
- NSAIDs (combined with anti-PUD agents)
- disease modifying drugs (to slow immune process)
- steroids (intra-articular)
- immune modulators (used as disease gets more severe)
- oral steroids
Give an example of disease modifying drugs used in RA.
- hydroxychloroquine
- methotrexate
Give an example of immune modulating drugs used in RA.
Biologics - TNF inhibitors (eg infliximab, adalimumab)
