B3.023 - Rheumatoid Arthritis Flashcards
What is non inflammatory arthritis
osteoarthritis, due to mechanical wear and tear
What is inflammatory arthritis
Immune system is the culprit, targeting the joints
What are the multiple types of inflammatory arthritis
Rheumatoid, psoriatic, chron’s disease related
What is the difference between primary and secondary osteoarthritis
Primary - due to mechanical derangement of joint
Secondary - due to trauma, genetic conditions
What are the most common places of osteoarthritis
Knee
Hip
Hands
What hand joints are the common points of osteoarthritis
PIPs
DIPs
Carpometacarpal (base of thumb)
What is the prevalence of RA
1%
What are the peak ages of onset of RA
50-75
RA spares what finger joints
DIPs
What are characteristics of presentation of RA
Symmetric polyarticular involvement
Upper and lower extremity involvement
Describe the onset of stiffness in RA patients
Morning stiffness usually >1 hour
Characterize morning stiffness in OA
<30 minutes
What do hands of RA patients look/feel like
Boggy, swollen and you cant see wrinkles
Describe the joint changes in RA patients hands
Ulnar deviation at MCPs
Swan neck
Boutonniere deformity
Cannot be straightened out in clinic
What are exam clues for osetoarthritis
Distribution of joints particularly in DIPs
Bony appearing changes
No ulnar deviation
What are extraarticular manifestations of RA
pleural effusion and pleurisy Pulmonary nodules Interstitial lung disease Pericarditis and pericardial effusion myocarditis Accelerated coronary artery disease
What is rheumatoid vasculitis
inflammation of blood vessels leads to occlusion and ischemia
what are extraarticular manifestations of RA in the eye
Secondary sjogrens/keratoconjunctivitis sicca
Episcleritis and scleritis
Corneal melt
What are the hematologic extraarticular manifestations of RA
Feltys syndrome
What is feltys syndrome
Splenomegaly, leukopenia, RA
What are the neurologic extraarticular symptoms of RA
Carpal tunnel
Entrapment neuropathy
Spinal cord compression
What is the strongest genetic link to RA
Shared epitope highly similar to AA sequence in alleles in HLA-DRB1 locus
What environmental factors contribute to RA
Silica exposure (Caplans syndrome)
Smoking
Peridontal disease
Gut microbiome
What is the relevance of Th17 in RA
Th17 cell is an important link with innate immune system, B cells serve as antigen presenting cells.
What is characteristic of H&E of RA
Fibrovascular tissue protrudes from inflamed synovium into the articular cartilage
How does joint destruction in RA happen
Osteoclasts ultimately result in erosions and join deformities
What labs can you do to diagnose RA
RF
CCP
ANA
What labs can you get to assist with disease activity
ESR, CRP
What labs can help you with medication monitoring
CBC with differential
Creatinine
AST/ALT
What is RF
Autoantibodies that recognize determinants of the Fc portion of IgG
What is CCP
Anti cyclic citrullinated peptide
seropositive v seronegative
Seropositive - RF or CCP positive
Seronegative - negative RF, CCP
What is a positive RF and CCP without arthritis indicative of
May identify patients in early process of disease
What can radiographs look for
periarticular osteopenia symmetric join space loss Marginal erosions soft tissue swelling no new bone formation
Distinguish between RA and OA on physical exam
RA - swelling, warm, erythema
OA - Bony changes
Distinguish between morning stiffness between RA and OA
RA - >1 hour
OA - <1 hour
Does OA have systemic symptoms?
No
Does RA have systemic symptoms?
It can
Distinguish between labs for RA and OA diagnosis
RA - +CCP/RF, elevated inflammatory markers
OA - normal findings
Describe findings on a radiograph for RA
Erosions, periostitis, joint-space narrowing
Describe findings on a radiograph in OA
Joint space narrowing, osteophytes, subchondral sclerosis
