Arthritis Flashcards
Rheumatoid arthritis
an inflammatory disease of exacerbations and remissions that attacks joints, but can also affect other tissues bc it is SYSTEMIC
Who is rheumatoid arthritis most commonly seen in
Women between 40 and 60 years old
Synovitis
membrane and synovial fluid become inflamed and damages the bone (seen in rheumatoid arthritis)
What causes rheumatoid arthritis?
no clear cause, but it has a genetic link and an immune-mediated response
“over activation” of the immune system where body produces antibodies agains itself
What can help prevent rheumatoid arthritis
if you block TNF or IL people tend to not have has many symptoms since the disease involves the activation of CD4 cells and production of cytokines
Explain the pathophysiology of Rheumatoid Arthritis
neutrophils, macrophages and lymphocytes are attracted to the area/joint where there are autoantibodies present
The autoantibodies are phagocytized and release destructive enzymes that attack joint cartilage and damage tissue
Inflammatory response follows= additional inflammatory cells come over = REACTIVE hyperplasia in the synovium
What does reactive hyperplasia during the inflammatory process of rheumatoid arthritis do?
causes vasodilation and increased vascular permeability = warmth, redness, and pain over joints
PANNUS
profusion of granulation tissue in rheumatoid arthritis = becomes destructive to the cartilage and underlying bone
** basically new blood vessels are formed in synovium = granulation tissue = PANNUS
What does PANNUS do in rheumatoid arthritis
spreads throughout the joint and causes deformity, reduced joint motion, and stiffness
**these destructive changes are irreversible
Manifestations of RA (Joints)
usually symmetrical and polyarticular
Involves fingers hands, wrists, feet, and knees
Pain and stiffness >30 min in AM
In the hand there is swelling and deformity of the proximal inter pharyngeal and metacarpophalangel joints)
Classic signs of RA
Swan neck deformity
Boutonniere deformity
Swan neck deformity
hyperextension of PIP joint with flexion of the DIP joint
Boutonniere deformity
flexion of the PIP and hyperextension of the DIP joint
Other joints involved in RA
knee damage = genu valgum (knock knee) ankles - interferes with walking toes rheumatoid nodules neck discomfort
Systemic manifestations of RA
Elevated ESR
Anemia
Rheumatoid nodules in pressure points
Vasculitis (inflamed blood vessels) causes ischemia and ulcercerations of visceral organs (heart lungs GI)
S/Sx of RA
fatigue, weakness, weight loss, low grade fever, anorexia
Rheumatoid Arthritis (other systemic manifestations
pulmonary disease
Cardiac disease (RA increases risk for MI or CHD)
Slceritis (vision probe)
Infection
Rheumatoid Factor
lab test that can be done, but NOT A TEST FOR RA
you can have RF and not have RA or you can have RA and not have RF
Anti-CCP (anti-cyclic citrullinated peptide antibodies)
aka ACPA
new test that helps diagnose RA = targets more specific autoantibodies that are seen in RA
Tx of RA
DMARDS (disease modifying anti rheumatic drugs
NSAIDS
Corticosteroids
Exercises (keeps muscles around the joints stronger) with physical and emotional rest
Osteoarthritis aka Degenerative Joint Disease (DJD)
NOT SYSTEMIC (RA is) MOST COMMON FORM OF ARTHITIS
weakening and breaking of collagen (d/t release of cytokines which release destructive enzymes)
Body is unable to repair the damage
Primary osteoarthitis
localized or generalized involvement of joints with no obvious cause
Secondary osteoarthritis
caused by congenital or acquired joint defects, trauma, metabolic disorders, or inflammatory diseases
Pathology of osteoarthritis
articular cartilage is eroded and destroyed exposing the underlying bone = rubbing of “bone to bone”
