RA

Question 1

What are the three hallmarks of RA?

Answer 1

Pain, swelling and stiffness.

Question 2

In 2011-2012 how many individuals had arthritis?

Answer 2

3.3 million.

Question 3

What are 95% of the cases due to?

Answer 3

Osteoarthritis, RA and gout (inflammatory crystals)

Question 4

Estimates of 2050

Answer 4

7 million Australians.

Question 5

It is known that there is an increase in prevalence of arthritis with increasing age. It is also known that arthritis is more prevalent amongst females. What age does it appear that this separation occurs?

Answer 5

It appears to occur at 45 years of age.

Question 6

What is RA?

Answer 6

Chronic inflammatory autoimmune disease of unknown aetiology associated with articular manifestations and extra articular manifestations.

Question 7

What does RA lead to?

Answer 7

Progressive disability (wheelchair bound 10-20 yrs), reduced life expectancy (3 to 10 years) and cost 30% of the pharmaceutical budget creating significant socio-economic costs.

Question 8

What are the primary manifestations of RA?

Answer 8

Synovial inflammation and synovitis erosion of bone cartilage and periarticular structures,

Question 9

Provide information pertaining to the epidemiology of RA?

Answer 9

-Prevalent in adult caucasian populations
Incidence 8-98/100000 per annum
Prevalence 0.5-1%
Peak onset age 40 (40-70) years

Question 10

Compare between synovitis and a normal joint.

Answer 10

Inflammatory infilitrate of cells (pannus)
Synovial hypertrophy
Inflitration of the joint with inflammatory mediators
Fibroblast and macrophages are there role in pathogeneis of disease
Osteoclasts that eat away the corners of joints
Wearing away of the corners of joints
Gradual onset of swelling, pain and stiffness.

Question 11

Describe articular manifestations

Answer 11

Insidious onset over weeks to months (55-65%). Pain, swelling and stiffness (greater or equal to an hour)- gel phenomenon if active during the day.
Intermediate- onset over dayst to weeks
Acute onset- peak within a few days (8-15%)

Question 12

Looking again at articular (joint manifestatons) Describe the joint involvement

Answer 12

Symmetrical
Commonly affected joints- small joints of the hands
Upper limbs
Metacarpophalangeal (MCP)
Proximal Interphalangeal (PIP)
Wrist
Lower limbs
Metatarsophalangeal (MTP)-
Characteristic deformities
Result from untreated persistent inflammation
Boutonniere, swan neck, Z,MCP, subluxation and ulnar deviation and radial wrist deviation.

Question 13

Discuss some aspects of joint involvement

Answer 13

MCP,PIP, wrists, knees, shoulders,ankles, feet,elbows , hips.

Question 14

What kind of swelling do your PIP display

Answer 14

Fusiform swelling

Question 15

Explain the mechanisms behind boutonniere (button hole) deformity.

Answer 15

Fixed flexion deformity of the PIP
Fixed hyperextenstion of the DIP
Protrusion of the PIP joint through its ruptured extensor tendon.

Question 16

Explain the mechanism behind the swan neck deformity

Answer 16

Fixed hyperexenstion of the PIP
Fixed flexion of the DIP
Flexor tendor rupture, lateral bands sublux dorsally at the PIP joint and tendon shortening at the DIP joint.

Question 17

Z defomrity of the thumb

Answer 17

Fixed flexion and subluxation of the MCP joint

Fixed hyperextension of the interphalangeal joint.

Question 18

List the typical hand deformities of RA

Answer 18

Z deformity, swan neck deformity, radial (lateral) wrist deviation, MCP sublaxation and ulnar deviation, boutonniere deformity