RA

Question 1

Epidemiology of RA?

Answer 1

1% of the population.
Women 2-3x men.
Onset at any age, most often 35-50yo

2-3x more common in 1st degree relatives

Question 2

Aetiology of RA

Answer 2

Genetic systemic autoimmune inflammatory disease which attacks joints Synovium primarily with some extra-articular symptoms. Triggered by exposure, infection, hormones or autoimmune factors.

Question 3

Pathogenesis

Answer 3

Hyperplastic synovial tissue (pannus) - thickened/many folds/releases inflammatory mediators, which erode cartilage, subchondral bone, articular capsule, and ligaments.
immune complexes migrate - systemic effects

Question 4

Clinical Manefestaions

Answer 4

Usually insidious
beginning with systemic and joint symptoms.
Early morning stiffness of affected joints, generalized afternoon fatigue and malaise, anorexia, generalized weakness, and occasionally low-grade fever. Joint symptoms include pain, swelling, and stiffness.
Involved joints become tender, with erythema, warmth, swelling, and limitation of motion.
The joints primarily involved:
Wrists and 2nd/3rd MCP, Proximal IP, MTP, Shoulders, Elbows, Hips, Knees, Ankles
Other extra-articular signs:
vasculitis causing leg ulcers or mononeuritis multiplex, pleural or pericardial effusions, pulmonary infiltrates or fibrosis, pericarditis, myocarditis, lymphadenopathy, Felty syndrome, Sjögren syndrome, scleromalacia, and episcleritis.
Improves with movement

Question 5

Symptoms

Answer 5

insideous 
morning stiffness
generalised fatigue in PM
malaise
anorexia
general weakness
lower grade fever
pain-stiffness >60 mins

Question 6

signs

Answer 6

Rheumatoid nodules, ulnar deviation of the fingers with slippage of tendons, swan-neck and boutonnière deformities, CTS, Joint deformity
decreased ROM - floppy jts - erosion

Question 7

Complications

Answer 7

Fixed deformities, particularly flexion contractures

Atlanto-axial subluxation -> cord compression

Lung/heart complications

Question 8

prognosis

Answer 8

good with treatment - methotrexate
otherwise decrease life expectancy - , with heart disease, infection, and GI bleeding accounting for most excess mortality; drug treatment, cancer, as well as the underlying disease may be responsible