ARTHRITIS & ARTHRITIDIS Flashcards
What is the first step in diagnosing a patient with arthritis or joint pain?
Determine if it is acute or chronic and if there is inflammation.
How long must joint pain persist to be considered chronic?
More than 6 weeks.
What is the most common chronic inflammatory arthritis?
Rheumatoid Arthritis (RA).
What is the unknown cause of Rheumatoid Arthritis (RA)?
Etiology is unknown.
What is the hallmark of Rheumatoid Arthritis in terms of joint involvement?
Symmetric polyarthritis.
What happens if Rheumatoid Arthritis is not managed early?
Articular cartilage and bone destruction. leading to functional disability.
Name three extraarticular symptoms of Rheumatoid Arthritis.
Fatigue. Subcutaneous nodules. Lung involvement.
What age range has the highest incidence of Rheumatoid Arthritis?
Between 25 to 55 years old.
How long does morning stiffness typically last in RA patients?
More than 1 hour.
Which joints are usually affected first in Rheumatoid Arthritis?
Small joints of the hands and feet.
What is the earliest pattern of joint involvement in RA?
Monoarticular (1 joint). oligoarticular (<4 joints) or polyarticular (>5 joints).
What joint deformity presents with PIP hyperextension and DIP flexion?
Swan-neck deformity.
What joint deformity presents with PIP flexion and DIP hyperextension?
Boutonniere deformity.
What joint deformity is characterized by 1st MCP subluxation and 1st IP hyperextension?
Z-line deformity.
What tendon is commonly affected in RA leading to reduced grip strength?
Flexor pollicis longus.
What is pes planovalgus commonly known as?
Flat foot.
Which cervical spine vertebrae are commonly affected in RA?
C1 and C2.
What are common neurologic symptoms of atlanto-axial involvement in RA?
Headache. numbness of upper extremities.
What factor increases the risk of extraarticular disease in RA?
History of smoking.
What two lab tests are commonly positive in Rheumatoid Arthritis?
Serum RF (Rheumatoid Factor) and Anti-CCP antibodies.
What is the gold standard of treatment for early Rheumatoid Arthritis?
Early and aggressive treatment.
What is the most common cause of functional disability in RA?
Articular cartilage and bone destruction.
What is the primary goal in the management of RA?
Prevent functional disability and joint destruction.
What age group has a higher prevalence of Gout , Osteoarthritis, Polymyalgia, and Septic Arthritis?
age < 60 years
What symptom differentiates Rheumatoid Arthritis from Osteoarthritis?
Symmetrical joint involvement.
What physical sign in the hand is indicative of advanced RA?
Ulnar deviation of fingers.
What should you always check in a patient with suspected RA aside from joints?
Extraarticular symptoms (lungs. heart. skin etc.).
What is the most common tendon to rupture in RA?
Flexor pollicis longus.
What extraarticular symptom may present as heart involvement in RA?
Pericarditis.
Why is early diagnosis and treatment of RA crucial?
To prevent functional disability and joint destruction.
What is the most common deformity in the hand in RA?
Swan-neck deformity.
What type of arthritis is most commonly associated with flexor tendon tenosynovitis?
Rheumatoid Arthritis.
What factor can increase the risk of tendon rupture in RA?
Flexor tendon tenosynovitis.
What age group typically experiences a plateau in RA incidence after initial increase?
After age 55 until 75.
What symptom is characteristic of inflammatory arthritis and differentiates it from other types?
Morning stiffness lasting >1 hour.
What test result suggests a higher likelihood of future RA in undifferentiated arthritis?
Positive serum RF or Anti-CCP antibodies.
What deformity causes a piano-playing-like appearance of the fingers in RA?
Z-line deformity.
What are the constitutional symptoms of extraarticular features in RA?
Fever. fatigue. malaise. depression. weight loss. cachexia
Why does cachexia in RA increase the risk of infection?
The decrease in appetite weakens the immune system.
What is a severe systemic vasculitis/infection fever temperature in RA?
> 38.3°C
What percentage of RA patients present with subcutaneous nodules?
30-40%
What are the features of subcutaneous nodules in RA?
Firm. non-tender. adherent to periosteum. tendon or bursa
Where do subcutaneous nodules commonly appear?
Forearm. sacral prominences. Achilles tendon
What condition may result from long-term methotrexate use in RA?
Accelerated growth of smaller nodules
What autoimmune condition affects 10% of RA patients?
Sjogren’s Syndrome
What are the key symptoms of Sjogren’s Syndrome?
Dry eyes (keratoconjunctivitis sicca). dry mouth (xerostomia)
What is the most common pulmonary symptom in RA?
Pleuritis
What are the clinical features of pleuritis in RA?
Chest pain. dyspnea. friction rub. pleural effusion
What lung condition is associated with smoking and high disease activity in RA?
Interstitial Lung Disease (ILD)
What pulmonary test shows a restrictive pattern in RA?
Pulmonary Function Test (PFT)
What syndrome results from RA plus silica exposure?
Caplan’s Syndrome
What are the less common pulmonary findings in RA?
Respiratory bronchiolitis. bronchiectasis
Which part of the heart is most commonly affected in RA?
Pericardium
What percentage of RA patients develop pericarditis?
<10%
What cardiac condition may result from coronary artery inflammation in RA?
Cardiomyopathy
What is the most common valvular heart disease (VHD) in RA?
Mitral regurgitation
Why does mitral regurgitation occur in RA?
Cardiomyopathy causes heart enlargement and mitral valve tethering.
What causes vasculitis in RA?
Deposition of inflammatory markers along the endothelium
What is the incidence of vasculitis in RA?
<1%
What cutaneous lesions can appear in RA vasculitis?
Petechiae. purpura. digital infarcts. gangrene. livedo reticularis
What is the most common hematologic abnormality in RA?
Normocytic. normochromic anemia
What is Felty’s syndrome?
Triad of neutropenia. splenomegaly and RA nodules
What type of leukemia can occur in RA?
T-Large Granular Lymphocyte leukemia
What is the most common lymphoma in RA?
Diffuse large B-cell lymphoma
What is the most common cause of death in RA?
Cardiovascular disease (CVD)
What cardiovascular diseases are increased in RA?
Coronary artery disease (CAD). stroke. congestive heart failure (CHF)
Why is osteoporosis common in RA?
Increased osteoclast activation and chronic glucocorticoid use
What is the most common fracture caused by osteoporosis in RA?
Hip fracture
What hormonal imbalance may occur in RA?
Hypoandrogenism (low testosterone. LH and DHEA)
What gene is associated with RA?
HLA-DRB1 gene
What environmental factors increase the risk of RA?
Smoking. Epstein-Barr virus. periodontitis
What immune hypersensitivity reaction type is associated with RA?
Type III hypersensitivity (immune complex-mediated)
What cells mediate the inflammatory infiltrate in RA?
T cells. B cells. plasma cells. dendritic cells. mast cells. granulocytes
What is the hallmark of pathologic changes in RA?
Synovial inflammation. bone erosion. cartilage thinning
What is pannus formation in RA?
Thickened synovial membrane with granulation-reactive fibrovascular tissue
What molecule promotes osteoclast differentiation in RA?
RANKL (Receptor Activator of Nuclear Factor Kappa-B Ligand)
What molecule inhibits osteoclast differentiation in RA?
Osteoprotegerin (OPG)
What cytokine is most responsible for inflammation and bone destruction in RA?
TNF-α (Tumor Necrosis Factor-alpha)
What is the role of DKK-1 in RA?
Inhibits bone formation by internalizing Wnt receptors on osteoblasts
What is the mechanism behind cardiomyopathy in RA?
Coronary artery inflammation leads to muscle dysfunction
What condition is most responsible for progressive joint destruction in RA?
Osteoclast activation
What is the most common site of subcutaneous nodules in RA?
Forearm
What autoimmune antibodies are associated with RA?
Rheumatoid factor (RF) and anti-CCP antibodies
What syndrome is characterized by RA
splenomegaly
What test can identify subclinical cardiac involvement in RA?
Echocardiography or cardiac MRI
What is the prognosis for Interstitial Lung Disease (ILD) in RA?
Poor prognosis due to progressive shortness of breath
What factor significantly increases the risk of RA?
Smoking
What common skin condition occurs in RA vasculitis?
Livedo reticularis
What pathology is responsible for bone destruction in RA?
Osteoclast-mediated bone erosion
What cytokine is responsible for activating the complement system in RA?
TNF-α
What is the most common cardiovascular manifestation of RA?
Coronary artery disease (CAD)
Why do some RA patients develop osteoporosis?
Prolonged steroid use and increased osteoclast activity
What factor predisposes RA patients to heart failure?
Diastolic dysfunction secondary to cardiomyopathy
Why do patients with long-standing RA have high cardiovascular mortality?
Chronic systemic inflammation increases atherosclerosis risk
What cytokine increases bone destruction in RA?
TNF-α
What is the role of fibroblast-like synoviocytes in RA?
Invade cartilage and bone. promoting joint destruction
What cytokines are mainly produced by T cells in RA?
IL-1
What lab test suggests severe vasculitis in RA?
Hypocomplementemia
What lung condition is commonly misdiagnosed in RA?
Caplan’s Syndrome
What is the primary treatment goal in RA?
Prevent joint destruction and functional disability
Why is early treatment critical in RA?
To prevent irreversible joint damage
