RA

Question 1

RA definition

Answer 1

a chronic disease with symmetrical joint involvement

Question 2

Epidemiology

Answer 2

Prevalent: less than OA
Onset: 30-50 years
Female>male
Genetic: possibility of a genetic etiology/redisposition//>MHC or HLA

Question 3

Pathogenesis

Answer 3

Inflamed synovial membrane
Infiltrated synovial fluid with neutropils
Pannus formation
Cartilage thinning

Question 4

Progression

Answer 4

Increased disability
Decreased inflammation

Question 5

Presentation

Answer 5

Fatigue, weakness
Loss of appetite
Joint pain, stiffness, muscle ache
Low grade fever

Question 6

Diagnostic (> 6 of the following)

Answer 6

Joint involvement: hands, wrists, feet
Serology
Duration of symptoms
Acute phase reactants

Question 7

Rheumatoid nodules

Answer 7

hands, elbows, forearms in erosive dx

Question 8

Vasculitis

Answer 8

Inflammation of small, superficial blood vessels

Long-term: stasis ulcers and infarction

Question 9

Pulmonary

Answer 9

Most common: pleural effusions, pulmonary fibrosis

Question 10

Ocular

Answer 10

Sjogren’s syndrome=keratoconjunctivitis + inflammation (sclera, episclera, cornea)

Question 11

Cardiac

Answer 11

Increased risk of CV mortality
Pericarditis
Conduction abnormalities
Rare: myocarditis

Question 12

Felty’s

Answer 12

splenomegaly, neutropenia

Question 13

Erythrocyte Sedimentation Rate (ESR)

Answer 13

non-specific

Normal: 0-20 mm/hr

Elevated in RA

Question 14

CRP

Answer 14

Normal 0-0.5

Elevated in RA

Question 15

Rheumatoid Factor

Answer 15

Antibody specific for IgM

Not all patients are RA and RF+

Question 16

Anti-CCP/ACPA

Answer 16

highly specific

marker for poor prognosis

present earlier in disease

Question 17

Antinuclear antibodies (ANA)

Answer 17

Elevated titers suggest autoimmune disease

more indicative of SLE

Question 18

Joint Aspiration

Answer 18

WBC: 5,000-50,000
Glucose: normal to low

Question 19

Radiographic

Answer 19

Joint space narrowing
Erosions of bone