7: RA Flashcards
What decades have peak incidence of RA?
4th and 5th
Is RA more common in males or females?
2.5x more common in females
Which ethnicity has a high prevalence of RA?
Some Native American populations have a rate of 5%.
How long must symptoms be present before RA can be diagnosed?
6 weeks
Is RA symmetrical or asymmetrical?
Symmetrical
Is RA in one joint or multiple?
Multiple (considered polyarticular)
Is stiffness in RA more common when getting up in the morning or in the afternoon after using the joints?
Morning (of over an hour, but gets better with movement)
Is it common to have swelling in RA?
Yes, there is inflammatory synovitis (palpable synovial swelling).
Which joints are usually involved in RA (3)?
- Wrists
- MCP Joints
- PIP Joints
Which joints are usually spared in RA (3)?
- DIPs of the Fingers
- Thoracolumbar Spine
- IPs of the Toes
Key features of RA (6)?
- Symptoms 6+ weeks.
- Inflammatory synovitis (palpable synovial swelling).
- Morning stiffness.
- Symmetrical and polyarticular.
- Nodules at pressure points (esp where people lean on their arms).
- Serological markers (Rheumatoid factor, anti-CCP).
Is the rheumatoid factor positive in all cases of RA?
No, 50% positive in first 6 months. 85% positive as disease progresses over 2 years. Low titer not specific for RA, but high titer early is a bad sign.
T/F If both RF and anti-CCP are positive there is a lower correlation with erosive disease.
False. There is a higher correlation with erosive disease.
What will an x-ray show in RA?
Marginal erosions and joint space narrowing.
What is the classification criteria for RA (2)?
- Must have at least 1 joint with clinical synovitis not better explained by another disease.
- Score 6/10.
How many RA points do you score for:
1 large joint
0 (1 joint inconsequential)
How many RA points do you score for:
2-10 large joints
1
How many RA points do you score for:
1-3 small joints
2
How many RA points do you score for:
4-10 small joints
3
How many RA points do you score for:
Over 10 joints (at least 1 small joint)
5
How many RA points do you score for:
Negative RF and anti-CCP
0
How many RA points do you score for:
Low positive RF or anti-CCP
1
How many RA points do you score for:
High positive RF + anti-CCP
3
How many RA points do you score for:
Normal CRP and ESR
0
How many RA points do you score for:
Abnormal CRP or ESR
1
How many RA points do you score for:
Duration less than 6 weeks
0
How many RA points do you score for:
Duration more than 6 weeks
1
What is the pathogenesis of RA?
Synovial fluid is over-produced in RA. It can cause pain and inflammation. Panus (old, thickened synovial fluid) will eat away at the cartilage.
What causes RA morning stiffness?
Fluid in joints is thick like bad oil in a car. Stiffness can return during the day, especially after rest.
T/F Early erosion on x-ray leads to more advanced disease.
True
Name extra-articular manifestations that may happen with RA (6).
- Fatigue
- Raynaud’s Syndrome
- Dry Eyes/Mouth (secondary Sjogren’s syndrome)
- Interstitial Lung Disease
- Pleuritis or Pericarditis
- Vasculitis
T/F RA treatment is aggressive early on.
True. If damage occurs early, then start aggressive treatment early.