Clin - Rheumatoid Arthritis Flashcards
what are the systemic features of RA
- fatigue, fever, anemia
- elevated acute phase reactants (ESR, CRP)
- constitutional sx - malaise, myalgia, depression
describe the immunopathogenesis of RA
- rheumatoid factor produced by RA synovium B cells
- rheumatoid factor fixes complement
- complement is consumed in the RA joint which recruits PMNs
- produces anti-CCP antibodies
what genes are associated with RA
HLA-DR4
DRB1 0401 or 0404
what causes the pannus formation in RA
B cells produce autoantibodies, cytokines (TNF-a, IL-1, IL-6)
leads to pro-inflammatory cytokine synovial proliferation, which increases synovial fluid and leads to a pannus that invades cartilage and bone
what labs and imaging would you get for a pt you suspect has RA
labs:
- RF
- anti-CCP test
- CRP
imaging:
- x-ray
- CT
how does pregnancy affect RA
RA improves during pregnancy and flares 4-6 weeks postpartum
what infections have been linked to RA flares
- peridontal dz
- EBV
- parvo
- B19
based on 2010 RA classification criteria, who should be tested for RA
- those who have at least 1 joint with definite clinical synovitis
- synovitis not better explained by another dz
describe the score based algorithm for joint involvement in RA
1 large joint: 1 point
2-10 large joints: 2 pt
1-3 small joints: 2 pts
4-10 small joints: 3 pts
> 10 joints (at least 1 small): 5 pts
a score > 6 = definite RA
describe the score based algorithm for serology in RA
negative RF and CCP: 0 pts
low RF or low ACCP: 2 pts
high RF or high ACCP: 3 pts
describe the score based algorithm for acute phase reactants in RA
normal CRP and ESR: 0 pts
abnormal CRP and/or ESR = 1
describe the score based algorithm for duration of symptoms in RA
< 6 weeks: 0
> 6 weeks: 1
what part of the axial spine is most often affected by RA
C1-C2
which joints of the hand are most often affected by RA
PIP and MCP
DIP almost never involved
what is always positive when a patient has rheumatoid nodules
always RF+
what joints in the feet are affected by RA
MTP
what is seen in the wrist with RA
- radial deviation
- synovial proliferation that compresses median nerve –> carpal tunnel syndrome
what is seen in the knees with RA
- bakers cyst in popliteal region (rupture is painful)
what skin findings can occur with RA
subcutaneous nodules on extensor surface of forearm
pyroderma gangrenosum
describe pyroderma gangrenosum
tender reddish purple papule that leads to necrotic, non-healing ulcer
what vasculitides can occur with RA
rheumatoid vasculitis: purpura, petechial, splinter hemorrhages and digital infarction
what cardiac dz processes are associated with RA
RA is an independent risk factor for CAD
associated with HF and pericarditis as well
what pulmonary issues are associated with RA
- pleuritis (most common)
- nodules, interstitial lung dz
- caplan syndrome: nodular densities after exposure to coal or silica dust
- pulmonary fibrosis
keratoconjuctivitis sicca is seen with what dz
sjogren’s
dry eyes
what antibodies are associated with sjogren’s
SS-A (RO) and SS-B (La)
what is the treatment for sjogren’s
anti-inflammatory and immunosuppression
what is felty’s syndrome
- RA
- splenomegaly
- neutropenia (< 2000)
- fever, anemia, thrombocytopenia
- RF and anti-CCP positive
30% of RA patients have positive ______ without having lupus
ANA antibody
list the disorders that can test false positive for RA
- 1-4% healthy elderly pts
- viral infections (Hep B and C)
- SLE
- polymositis
- sjogren’s
- systemic sclerosis
- lymphoma, myeloma
- TB, mononucleosis, syphilis, sarcoid
what is the first DMARD given for RA
methotrexate
what is the main side effects of using anti-malarial drugs for RA
macular damage to retina, blurred vision, halos, photophobia
