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Rheumatoid Arthritis > RA > Flashcards

RA Flashcards

1
Q

Rheumatoid Arthritis

A
  • autoimmune, systemic, inflammatory, chronic condition
  • affects synovium
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2
Q

Demographics

A

Caucasians, particularly FEMALES between 25-50 years old.

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3
Q

Etiology of Rheumatoid Arthritis

A
  1. Idiopathic/Unknown;
  2. Microvascular injury triggers the inflammatory process (theory)
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4
Q

Main causes of Rheumatoid Arthritis

A
  1. Infection
  2. Human Leukocyte Antigen DR4 (HLA DR4)
  3. Rheumatoid Factor
  4. Anti Citrullinated Protein Antibody (ACPA)
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5
Q

Human Leukocyte Antigen DR4

A

It predisposes individuals to have RA if positive, but DOES NOT CAUSE RA.

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6
Q

Rheumatoid Factor (RF)

A
  • antibodies vs IgG
  • STRONGEST predictor of RA
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7
Q

Seropositive vs Seronegative (Rheumatoid Factor)

A

Seropositive > worse prognosis
Seronegative > better prognosis.

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8
Q

Anti Citrullinated Protein Antibody (ACPA)

A
  • metabolism of dead cells
  • most sensitive finding for RA
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9
Q

Pathology

A

Synovial T-Cell Proliferation (Pannus formation) > dissolves collagen (Erosion) > leading to IRREVERSIBLE deformities

  • aka “Erosive Arthritis”
  • not irreversible = not RA
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10
Q

1987 Revised Criteria for Classification of RA

A

5-7 can help confirm but does not necessarily diagnose RA

  1. Morning stiffness (at least 1 hr) : HALLMARK SIGN
  2. Arthritis of 3 or more joint areas
  3. Arthritis of hand joints
  4. Symmetric arthritis
  5. Rheumatoid nodules
  6. Serum Rheumatoid factor (+ RF)
  7. Radiographic changes

If #1-4 is positive for 6 consecutive weeks = highly suggestive of Rheumatoid Arthritis

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11
Q

Arthritis of 3 or more joint areas (Polyarticular)

A

at least 3 joint areas have had soft tissue swelling or fluid

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12
Q

Symmetric arthritis

A
  • SIMULTANEOUS involvement of the SAME joint areas on BOTH SIDES of the body
    (bilateral involvement of PIP, MCPs or MTPs is acceptable)
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13
Q

Rheumatoid nodules

A

Subcutaneous nodules over:
bony prominence/extensor surfaces/juxta articular regions

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14
Q

Radiographic Changes (A B C D E S)

A

Abnormal alignment
Bone involvement
Cartilage destruction
Deformities
Erosion
Soft tissue swelling

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15
Q

Top Predictors of RA

A
  1. Anti Citrullinated Protein Antibody (ACPA)
  2. Rheumatoid Factor (strongest predictor)
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16
Q

2010 ACR/EULAR Classification Criteria for RA

A

Joint Distribution (0-5)
Serology (0-3)
Symptom Duration (0-1)
Acute Phase Reactants (0-1)

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17
Q

2010 ACR/EULAR Classification Criteria for RA

A

Definite RA ≥6

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18
Q

Score of < 6

A

The patient might fulfill the criteria prospectively over time,
or retrospectively if data on all four domains have been adequately recorded.

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19
Q

Small joints in RA

A

MCP
PIP
MTP 2-5
Thumb IP
Wrist

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20
Q

Large joints in RA

A

Shoulder
Elbow
Hip
Knee
Ankles

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21
Q

Definition of >10 joints in RA

A
  • At least ONE small joint;
  • additional joints: temporomandibular, sternoclavicular, and others reasonably expected in RA.
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22
Q

ESR Formula

A

ESR = (Age + 10) / 2

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23
Q

Most commonly affected joints in RA

A

MCP
Wrist
PIP
MTP
Shoulder
Ankle
C Spine
Hip
Elbow

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24
Q

Least affected joint in RA

A

TMJ

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25
Q

Swan Neck Deformity (Hand)

A

Flexed DIP, Extended PIP

Cause:
reflex muscle spasm of intrinsics
swelling of the volar capsule of PIP
rupture of EDC at DIP

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26
Q

Boutonniere Deformity (Hand)

A

Extended DIP, Flexed PIP

rupture of the Central Slip.

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27
Q

Ulnar Drift ‘Z Deformity’ (Hand)

A

Subluxation at the wrist joint

Wrist deviates to radial side, MCP and fingers deviate to ulnar side, leading to absent power grip.

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28
Q

Vaughn-Jackson Deformity

A

Rupture of the 4th and 5th extensor tendon (EDC)

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29
Q

Mannerfelt aka Boutonniere Deformity of the Thumb or Nalebuff Deformity

A
  • Rupture of the FPL tendon at the first CMC;
  • thumb is in extension.
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30
Q

Nalebuff

A

I. Boutonniere of the Thumb
II. Boutonniere with Add/Sublux. At CMC
III. Swan Neck with Add/Sublux. At CMC
IV. Gamekeeper’s Thumb
V. Swan Neck alone
VI. Bone Loss/Arthritis Mutilans

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31
Q

Bone Loss/Arthritis Mutilans

A

Severe deformity

Includes:
Opera Glass Hand (+) RA
Telescoping Sign (+) PSA

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32
Q

Piano Key Sign

A

(+) Torn DRU Ligament

Up and down movement of the ulna when pressed by the examiner

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33
Q

Common knee deformity

A
  • Flexion Contracture (pain relieving position)
  • Subluxation
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34
Q

Baker’s Cyst

A

Prevents knee extension

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35
Q

Hammer Toes (MTP)

A

Flexed PIP

Most common foot deformity, leads to absent push off and apropulsive gait.
(+) Callus formation at PIP Joint

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36
Q

Metatarsalgia

A

Inflamed ball of the foot

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37
Q

Hallux Valgus

A

A condition affecting the big toe, often leading to a bunion.

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38
Q

Shoulder Joint

A
  • LOM typically observed 1st of IR, then Add.
  • in RA: GH Joint
  • in Degenerative Arthritis: AC joint
  • Sublaxation: weakness muscles
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39
Q

In Rheumatoid Arthritis (RA), which joint is affected?

A

GH Joint

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40
Q

In Degenerative Arthritis, which joint is affected?

A

Acromioclavicular (AC) Joint.

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41
Q

What causes subluxation in the shoulder?

A

Weakness of muscles.

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42
Q

Hindfoot pronation (Ankle)

A

foot rolls inward during walking

43
Q

Flat foot

A

collapsed medial arch

44
Q

splay foot

A

Collapsed transverse arch

45
Q

Cervical spine

A
  • C1 - C2
  • laxity of the transverse atlantal ligament (cord compression)
46
Q

Potential fracture associated with C1-C2

A

Fracture of the Odontoid Process (hangman’s/tear drop fracture)

47
Q

Loss of motion (LOM) in the cervical spine

A

Neck rotation.

48
Q

What can cause subluxation in the cervical spine?

A
  • Compression of the spinal cord
  • possible asphyxia
49
Q

management (Mx) for cervical spine issues

50
Q

Pain location in the hip joint

A
  • Groin (most common)
  • buttocks
  • knee
51
Q

Hip joint

A

LOM: Internal rotation (IR)

52
Q

Common condition of hip joint

A

Protrusio Acetabuli

53
Q

Elbow joint

A
  • Flexion contracture
  • loss of pronation & supination
54
Q

Olecranon Bursitis (Elbow Joint)

A

Acute: Student’s Elbow
Chronic: Miner’s Elbow

55
Q

TMJ

A

Limitation of mouth opening (usually 2 inches)

56
Q

Heart complication of RA

A

Pericarditis

Includes constrictive pericarditis and cardiac tamponade.

57
Q

Constrictive pericarditis

A

Enlarged pericardium constricts myocardium causing hypertrophy of myocardium.

Leads to heart hypertrophy, tachycardia, and cardiac arrest.

58
Q

Most common cause of death in RA

A

Heart impairment/Cardiovascular Disease.

59
Q

Lung complication of RA

A

Caplan’s Syndrome.

aka Coal Worker’s Pneumoconiosis

60
Q

PNS Complication of RA

A

CNS is not affected in RA, only in SLE.

Impingement:
- wrist (CTS)
- elbow (Cubital Tunnel Syndrome)
- knee (Tarsal Tunnel Syndrome)

61
Q

Blood complication in RA

A

(+) Anemia (anemia of chronic disease/hemolytic).

  • WBC & platelets are within normal limits
  • progress to Felty’s Syndrome
62
Q

Felty’s Syndrome

A

S L L A A N T

Splenomegaly
Lymphadenopathy
Leukopenia
Arthritis
Anemia of Chronic Diseases
Neutropenia
Thrombocytopenia

63
Q

Eye complication of RA

A

Sicca Syndrome/Keratoconjunctivitis Sicca

dryness of eyes.

64
Q

Sjogrens Disease (Eye)

A

aka:
- Autoimmune Exocrinopathy
- Gougerot’s Disease
- Nikulicz’s Disease

65
Q

Triad (Eye)

A

I. Xerophthalmia (dry eyes)
II. Xerostomia: dry mouth; bilateral parotiditis
III. Arthritis

can lead to (+) Lymphoma

66
Q

Test for Xeropthalmia (Dry eyes)

A

I. Schrmer’s Test: apply filter paper on lower lid
- (+) test, 1st Sjogrens, if wala, RA, if wala, SLE, if wala, Scleroderma, if wala, Mixed Connective Tissue Disease, if wala, NOTA

II. Rose Bengal Test

67
Q

Dyspareunia

A

Painful female sexual intercourse due to dry female genitalia

68
Q

(4) Stages of RA progression

A

Stage 1 (Mild)

Juxtaarticular Osteoporosis

69
Q

Stage II (Moderate)

A

Osteoporosis with or without slight bone destruction
adjacent muscle atrophy
Rheumatoid nodule

70
Q

Stage III (Severe)

A

Bone destruction, deformities
Extensive muscle atrophy
Rheumatoid nodules

71
Q

Stage IV (Terminal)

A

Stage III + Bony Ankylosis

Ankylosis is not seen in OA.

72
Q

Functional class of RA

A

Class I

Individual with self-care vocation & avocational activities

73
Q

Functional class of RA

A

Class II

Independent with self-care and vocation but limited with avocational activities

74
Q

Functional class of RA

A

Class III

Independent with self-care but limited with vocation and avocation activities

75
Q

Functional class of RA

A

Class IV

Dependent (Wheelchair bound)

76
Q

Functional class of RA (Simplified)

A

Class I: self care, vocational, avocational
Class II: self care, vocational
Class III: self care
Class IV: none

77
Q

Polymyalgia Rheumatica

A

stiffness and pain of proximal muscles (shoulder, pelvic girdle, and cervical)

Elderly females, over 50 years old

78
Q

Symptoms of Polymyalgia Rheumatica

A

Initial symmetrical stiffness
Initial joint involvement asymmetric
Fatigue
Low Grade fever
Muscle pain > Joint pain

79
Q

Ang S E C R E T ni lola poly

A

Stiffness (proximal muscles)
Elderly
Caucasians
Rheumatism (Knee joint)
ESR Elevated (60-100mm/hr)
Temporal Arthritis (Giant Cell Arthritis)

80
Q

ACR criteria for Polymyalgia Rheumatica

A
  1. Morning stiffness > 45 mins = (2)
  2. Hip pain/LOM= (1)
  3. (-) RF/ACPA = (2)
  4. No other joints involved = (1)
81
Q

Ultrasound findings of Polymyalgia Rheumatica

A
  1. At least 1 shoulder joint with deltoid bursitis or biceps tenosynovitis or glenohumeral synovitis;
    at least one hip joint with synovitis or trochanteric bursitis = (1)
  2. Both shoulders with deltoid bursitis or biceps tenosynovitis, or glenohumeral synovitis = (1)
82
Q

Positive diagnosis of Polymyalgia Rheumatica

A

(+) PMR >/= 5

all ACR findings plus at least 1 ultrasound finding

83
Q

Giant Cell Arthritis

A

Headache
blurring of vision
jaw claudication
scalp pain

affects medium arteries

84
Q

MC Sx: Giant Cell Arthritis

A

Irreversible blindness

85
Q

ACR criteria for Giant Cell Arthritis

A
  1. Age of onset > 50 years old
  2. New headaches
  3. Elevated ESR > 50 mm/hr
  4. Temporal artery abnormality (pulselessness, tenderness)
  5. (+) biopsy of the temporal artery for vasculitis
86
Q

Juvenile Idiopathic Arthritis (JRA/JIA)

A

I. Pauciarticular/Oligoarticular (most common JIA)
II. Polyarticular/Polyarthritis
III. Systemic/Still’s Disease (most rare & severe)

87
Q

Most common type of JIA

A

Pauciarticular/Oligoarticular JIA

  • 1-4 joints
  • large joints: knee, ankle, wrist, and TMJ; asymmetric
88
Q

How many joints are affected in Pauciarticular/Oligoarticular JIA?

A

1-4 joints.

89
Q

Which joints are commonly affected in Pauciarticular/Oligoarticular JIA?

A

Large joints: knee, ankle, wrist, and TMJ; asymmetric.

90
Q

What is the gender and age prevalence for Pauciarticular/Oligoarticular JIA?

A

More common in females; ages 1-4 years old.

91
Q

Extended Pauciarticular JIA

A

If one more joint is added after 6 months

92
Q

Two types of Pauciarticular JIA?

A
  1. (+) ANA and
  2. (-) ANA, (+) HLA B27
93
Q

What does (+) ANA indicate in Pauciarticular JIA?

A

It is associated with iridocyclitis, which can lead to blindness.

94
Q

Polyarticular/Polyarthritis JIA

A

5 or more joints

95
Q

Gender and age prevalence for Polyarticular JIA

A

Females, > 8 years old

96
Q

Polyarticular JIA

A

Small joints of the hands, symmetrical (affected)

97
Q

Two types of Polyarticular JIA

A

(+) RF and (-) RF

98
Q

Prognosis for (+) RF Polyarticular JIA

A

Worst prognosis due to organ involvement (5-10%)

99
Q

Prognosis for (-) RF Polyarticular JIA

A

Better prognosis with complete remission (95%)

100
Q

Systemic/Still’s Disease

A

rarest and most severe type of JIA

101
Q

Gender prevalence for Systemic/Still’s Disease

A

Equal prevalence in males and females.

102
Q

Key symptoms of Systemic/Still’s Disease

A

(+) High Grade Fever
Daily
OD
Still’s Rash.

103
Q

Characteristics of Still’s Rash

A

Salmon Pink color
disappears with depression of fever, and is nonpruritic.

Rheumatoid Arthritis (2 decks)

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