Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Imaging and Diagnosis > RA > Flashcards

RA Flashcards

1
Q

What is Juvenile Rheumatoid Arthritis?

A

Aka Juvenile Idiopathic Arthritis (JIA), Juvenile Chronic Arthritis (JCA)
Inflammation of the connective tissues, characterized by major changes in the joints including inflammation, contractures, and joint damage which affect mobility, strength and endurance
Causes:
- Unknown
- Autoimmune disease – attacking cells with biological chemicals, causing inflammation
It affects the Articular and Extra-articular structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 main types of JRA are?

A
  1. Pauciarticular JRA (common)
    - affects 4 or fewer joints
    - aka Oligoarticular JIA
  2. Polyarticular JRA
    - affects 5 or more joints
  3. Systemic JRA (rare)
    - the symptoms are not usually related to joints
    - high fever
    - loss of appetite
    - weight loss
    - swollen lymph node
    - liver and spleen
    - serious anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the joints most commonly affected by JRA?

A
  • IP & MCP joints of hand
    - wrist
    - knee
    - MTP & IP of foot
    - Large joint involved ONLY in association with small joint involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the symptoms of JRA?

A

Asymptomatic but symptoms may include:
- Swollen, red, warm joint – lasts for 6 weeks
- Limping or problems using a limb
- High fever
- Rash
- Stiffness, pain and limited ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the Extra-articular Manifestations of JRA?

A
  • Generalized or local growth disturbances
    - Delayed puberty
    - Pericarditis, myocarditis, rarely endocarditis
    - Pleural effusion – rarely
    - Pulmonary fibrosis
    - Hepatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risk factors of JRA?

A

Risk Factors:
- None
- Girls > Boys (2:1)
- <16 yoa
- Family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the Radiological Findings of JRA?

A
  • Soft tissue swelling
    - Periarticular Osteoporosis
    - Growth disturbance
    - Loss of joint space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the complications of JRA?

A
  • Destruction of joints
    - Slow or uneven growth
    - Decreased or loss of vision
    - Anaemia
    - Chronic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Rheumatoid Arthritis?

A

A systemic connective tissue inflammatory disease of unknown etiology
Mainly affects synovial joints
Peak age of onset: 20-60 yoa
- highest incidence 40-50 yoa
- < 40 = females 3:1
- > 40 = Male: female 1:1
Mainly affects:
- peripheral joints of hands & feet
- larger joints (hip, knee, shoulder)
- Cervical-spine
A positive Rheumatoid Factor (RF or RA Factor)
- an antibody present in the blood of many patients with RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the Pathophysiology of RA?

A

Acute synovitis > ST swelling (fusiform)
Hyperemia > regional or periarticular
Pannus > uniform loss of joint space
> marginal erosions (bare areas)
Intraosseous pannus and synovial fluid intrusions > subchondral bone cysts
Fibrous tissue metaplasia > ankylosis
Ligament laxity/rupture > deformities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical features of RA?

A

Main target organ: synovial lining of joints, bursae and tendon sheaths
- Synovitis results in erosion of articular cartilage and marginal bone, with subsequent joint destruction
Extra-articular features are common, numerous and sometimes serious
Hallmark = bilateral/symmetrical peripheral joint pain and swelling especially wrist, MCP, and PIP joints (commonest presenting symptoms)
- “Jelling phenomenon” (AM stiffness or after prolonged resting)
Deformities (later)
Muscle atrophy and weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the signs and symptoms of RA?

A

Joint inflammation
Tender, warm swollen joints
Symmetrical pattern
Pain and stiffness
Symptoms in other parts of the body
Nodules
Anemia
Fatigue, occasional fever, malaise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the early findings radiological features for RA?

A
  • Fusiform soft tissue swelling
  • Juxta articular osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the later findings radiological features for RA?

A
  • Joint subluxations/malalignment
    • Uniform symmetric joint space narrowing
    • Marginal subchondral erosions
    • Joint destruction
    • Collapse
    • Ankylosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the findings of RA in the hand?

A

Affected in almost all patients
MC affects MCP and PIP joints
DIP - rare to never
Fusiform swelling, periarticular osteoporosis
Concentric loss of joint space (uniform)
Marginal erosions
- erosions at radial & ulnar aspect of articulation
- larger at the proximal bone of the articulation
- affects the radial side more than the ulna

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are complications of Hand RA?

A

Deformities - late but common complication:
1. Mallet Finger
disruption of the distal attachment of the extensor tendon to the terminal phalanx
Drop finger
2. Boutonniere Deformity
flexed PIP and hyperextended DIP
3. Swan Neck Deformity
hyperextended PIP and flexed DIP
4. Ulnar Deviation
seen in 25-50%
“Zig-Zag” when associated with radial deviation in the wrist.

17
Q

What are the findings of RA in the wrist?

A

Erosion and swelling at distal ulna, triquetrum and pisiform
Tendinitis and tenosynovitis of extensor carpi ulnaris tendon
Inflamed synovial tissue in pre-styloid recess and inferior radioulnar compartment
Ankylosis is end stage
- radiocarpal joint space remains
Radial deviation

18
Q

What are the findings of RA in the elbow?

A

Frequently involved in RA
Commonly bilateral but may be more marked in dominant extremity
Decreased flexion and extension
Pain and local tenderness
Swelling over the lateral aspect between radial head and olecranon
Bursitis - also in gout, trauma, and infection
Fat pad seen in up to 90% of rheumatoid cases
Periarticular osteoporosis
Uniform joint loss
Erosions and cystic changes

19
Q

What are the findings of RA in the forefoot?

A

Common in RA
Intermittent pain, swelling and deformity (forefoot spread, hallux valgus, fibular deviation of digits, hammer toe, “cock-up” toe)
Loss of joint space - 5th MTP joint
Erosions
- predominately medial surface of each MT head with exception of 5th
- lateral aspect erosons early and important finding
Fibular deviation with exception of the 5th digit
Dorsiflexion and lateral subluxation or dislocation of the proximal phalange (Lanois deformity).

20
Q

What are the findings of RA in the shoulder?

A

Frequently involved in RA
Decreased ROM
Subacromial bursitis  prominent soft tissue swelling => erosions along Superolateral aspect of humeral head
Diffuse loss of joint space
Cysts and sclerosis
Possible erosions on the medial surgical neck
Rotator cuff degeneration - commonly seen
Progressive elevation of humeral head as deltoid acts unopposed
Reduced distance between acromion and humeral head
Sclerosis and cyst formation on adjacent portions of humeral head and acromion
AC joint may widen (usually bilaterally)
DDX from Hyperparathyroidism

21
Q

What are the findings of RA in the heel?

A

Retrocalcaneal bursitis:
soft tissue swelling at the posterior aspect of the calcaneus
erosions at posterior and superior aspects
Achilles tendinitis:
enlargement and blurring of the tendon
irregularity of the attachment site
Plantar fasciitis:
well-defined calcaneal spurs (DDX from sero (-)

22
Q

What are the findings of RA in the knee?

A

Very common region
Soft tissue swelling often prominent from synovial effusion in suprapatellar and popliteal regions.
Baker’s Cysts are common complication
Marginal erosions at peripheral aspects of femur and especially the tibia
Subchondral cysts.
Uniform, bicompartmental loss of joint space
- Radiographic hallmark
Possible widening of intercondylar notch

23
Q

What are the findings of RA in the hip?

A

Usually late
seen in long-standing and severe disease in approx 35% of pts
Decreased internal rotation, extension and abduction
Uniform loss of joint space (axial displacement)
Bilateral involvement
Protrusio acetabuli - joint space reduction and axial pressure of femoral heads + intraosseous hyperemia)
Approx 15% of pts with RA of hip
Cysts, sclerosis, & erosions near the femoral head
Necrosis may complicate especially if on steroids

24
Q

What are the findings of RA in the SI joint?

A

Seen in 25% to 35% in long standing disease
Unilateral or bilateral
Asymmetric
Iliac erosions
Mild sclerosis
Ankylosis infrequent

25
Q

What are the findings of RA in the C spine?

A

Seen in 25% to 35% in long standing disease
Unilateral or bilateral
Asymmetric
Iliac erosions
Mild sclerosis
Ankylosis infrequent

Clinical Imaging and Diagnosis (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions