Joint Disorders - Rheumatoid Arthritis Flashcards
RA
Rheumatoid Arthritis
What is RA considered?
an autoimmune disorder causing chronic systemic inflammatory disease
What % of the population does RA affect?
more than 1%
major cause of disability
RA has a higher incidence in men than women.
True or False
False
It has a higher incidence in Women
How does damage of joints in RA progress?
remission, exacerbations
OS insidious
symmetric involvement of small joints e.g. fingers
followed by inflammation,destruction additional joints (e.g. wrist,elbow,knees)
many have involvement of upper cervical vertebrae and TMJ
TMJ
TMD
Temporomandibular Joint, Disorder
What does the severity of RA vary and reflect on?
mild to severe
reflecting number of joints, degree inflammation and rapidity of progression
Pathophysiology RA: What is the first step in the development of RA?
abnormal immune response = inflammation synovial membrane vasodilation ,increased permeability = formation exudate (red, swollen and painful joint)
synovitis appears result immune abnormality
rheumatoid factor RF
antibody against immunoglobulin G present blood majority w RA
RA also present in synovial fluid
first period acute inflammation, joint may appear to recover completely
Pathophysiology RA: What is the process during exacerbations of RA.
During each exacerbation/acute period inflammation and further damage occur in joint previously affected and additional joint become affected by synovitis.
- Synovitis. Inflammation recurs, synovial cells proliferate.
- Pannus formation. Granulation tissue from synovium spreads over articular cartilage. This granulation tissue called pannus, release enzymes and inflammatory mediators destroying cartilage.
- Cartilage erosion. Cartilage is eroded by enzymes, from the pannus and in addition nutrients that are normally supplied by synovial fluid to cartilage are cut off by the pannus. Erosion of the cartilage creates an unstable joint.
- Fibrosis. In time pannus between the bone ends become fibrotic, limiting movement. This calcifies and joint space is obliterated.
- Ankylosis. Joint fixation and deformity develop
RF
Rheumatoid Factor
an antibody against immunoglobulin G as well as other immunological factors is present in the blood of majority persons with RA
Pathophysiology RA: What changes frequently alongside exacerbation of RA?
- acute inflammation = disuse atrophy of muscles and stretching of tendons and ligaments = decreasing supportive structures in unstable joint
- alignment of the bones in joint shifts, depending on how much cartilage eroded and balance achieved between muscles
- inflammation and pain may cause muscles spams further drawing bones out of normal alignment
-contractures and deformity with subluxation de3velop
various contractures and deformities e.g.ulnar deviation, swan neck, boutonniere deformity may occur in hands depending on degree flexion and hyperextension in joints
-mobility greatly impaired as joints damaged and deform, walking become difficult when knees and ankles affected
What other effects does the inflammatory process have on the body?
rheumatoid or subcutaneous nodules may form on the extensor surfaces of the ulna
nodules may form on pleura, heart valves, or eyes
What is though to be the cause of Sytemic Effcts in RA?
arise from circulation immune factors, causing marked fatigue, depression and malaise anorexia and low-grade fever
iron-deficiency and anaemia with low serum iron levels is common;
when it results in RA this anaemia is resistant in iron therapy.
Etiology
although considered autoimmune disorders, exact nature not full determined
- genetic factor is present with familial predisposition
- abnormality seems linked to several viral infections
- more common women than men
- increasing incidence with age
RF not present in all patients with RA yet may be present certain other disorder
RA more common women than men
Signs and Symptoms RA:
Insidious at the onset, to manifest as mild general aching and stiffness.
- Inflammation may be apparent first in fingers or wrists. It affects the joints in symmetric (bilateral) fashion, usually, more than one pair of joints is involved.
- The joints appear red and swollen and often are sensitive to touch as well as painful.
- Joint stiffness occurs following rest, which then eases with mild activity as circulation through joint improves.
- Joint movement is impaired by welling and pain frequently, daily activities become difficult including dreasasing, food preparation, and oral hyegiene
- Malocclusion ion of teeth may develop from TMJ involvement as condyle is damaged
- Sytemic signs are marked diring exacerbation and include fatigue, anorexia, mild fever, generalised lymphadenopathy
