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PHTH 565 RHEUMATOLOGY > RA > Flashcards

RA Flashcards

1
Q

Are women or men more likely to have RA

A

women

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2
Q

When is the onset for RA

A

35-50

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3
Q

Which populations have the highest levels of RA? The lowest?

A

Aboriginal

Asian

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4
Q

What is the pathophysiology of RA

A

Autoimmune disease

- In response to immunologic factors synovial membranes become inflamed

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5
Q

What triggers RA

A

Genetic susceptibility and environmental triggers

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6
Q

What are the characteristics of synovitis

A
  • Hyperplasia (synovial cell proliferation)
  • Increased vascularity
  • Infiltration of inflammatory cells - resulting in the production of enzymes that causes inflammation
  • Articular damage cased by pannus
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7
Q

what is pannus

A

granulation tissue formed within synovium

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8
Q

What is the difference between joint damage in OA and RA

A

In an RA affected joint damage is throughout the joint surface (unlike OA where you see the most damage near site of stress)
- In RA there can also be bone damage leading to osteoporosis

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9
Q

What happens when a joint is affected by RA

A
  • In response to immunologic factors, the synovium becomes swollen and cells begin to proliferate
  • A densely cellular membrane )pannus) spread over the cartilage and erodes the underlying cartilage and bone
  • Pannus can cause fibrous scar tissue, adhesions, and ankylosis on opposite articular surfaces
  • Bone becomes more osteopenic, ligaments and tendons are damage, surrounding muscle deteriorates
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10
Q

What is the response of the synovium to immunologic factors

A

becomes swollen and cells begin to proliferate

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11
Q

What is the result of pannus spreading over the articulare cartilage

A

erodes the underlying cartilage and bone

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12
Q

What is the result of pannus spreading to the opposite articular surface

A

creates fibrous scar tissue, adhesions, and ankylosis

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13
Q

What is the result of tendon and ligament damage in RA

A

increased risk of rupture

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14
Q

What is the result of ligament damage and deteriorating musculature

A

leaves joints unstable and prone to deformity

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15
Q

Familial history of RA increases overall risk by ___

A

2x

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16
Q

What is the genetic marker for RA

A

Rheumatoid factor HLA-DR4

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17
Q

Rheumatoid factor (RF) HLA-DR4 is present in ___% of people with RA

A

80%

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18
Q

Rheumatoid factor (RF) HLA-DR4 accounts for ___% of the genetic risk in RA

A

30%

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19
Q

High RF can also be present in people with what conditions?

A

Lupus, syphilis, chronic or idiopathic pulmonary fibrosis

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20
Q

when else might you see elevated levels of RF

A

in aging population - 5-10% of healthy people>60yrs have it

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21
Q

What are the risk factors for RA

A
  • Genetics
  • Pregnancy & hormonal factors
  • Environmental factors - Smoking, occupation, diet,
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22
Q

What occurs to your risk of RA following child birth

A

increases

23
Q

What may be a reason for why risk of RA increases following child birth

A

breast feeding - associated with increased prolactin

24
Q

Oral contraceptive use Increases or decreases you risk of RA

A

decreases by postponing disease onset

25
Q

What are the findings for risk of RA in those using postmenopausal hormones

A

inconsistent

26
Q

smoking use Increases or decreases you risk of RA

A

increases - especially in men

27
Q

What type of RA is smoking associated with

A

seropositive RA

28
Q

Which occupations are associated with a risk in RA

A

Miners (silica exposure)

Farmers (pesticide exposure)

29
Q

Which dietary choices are associated with decreased risk of RA

A
  • Olive oil consumption
  • Fish consumption (>3times/week)
  • Drinking tea (>3cups/day) - antioxidants
30
Q

What are the 7 criteria for RA

A
  1. Morning stiffness >1 hours (>6 weeks)
  2. Arthritis of > 3 joints (>6 weeks)
  3. Arthritis of hand joints (>6 weeks)
  4. Symmetric arthritis (>6 weeks)
  5. Rheumatoid nodules
  6. Serum rheumatoid factor positive
  7. Radiographic changes
31
Q

How many RA criteria need to be met for a diagnosis

A

4 or more

32
Q

Clinical features of RA

A
  • Pain
  • Fatigue
  • Stiffness
  • decreased ROM
  • often involves small joints
  • often symmetrical
  • swelling
  • joint deformity
  • Instability of the joint
  • Muscle atrophy, general deconditioning
  • Extraarticular features
33
Q

When the disease is quieted down - what are acceptable training levels

A

you can train at high intensities

34
Q

Where do rheumatoid nodules develop?

A

subcutaneously in elbow, finger, wrist, hip joints, lower back and achilles tendon
Occasionally in heart and lung tissue

35
Q

rheumatoid nodules are found in ___% of people at the time of diagnosis

A

7%

36
Q

Rheumatoid nodules affect __% of patients are some point during their disease

A

30%

37
Q

What sensations occur during the warming or stress relief of raynauds patients

A
  • Numb, prickly feeling or stinging pain
38
Q

Raynauds is present is ____ of RA patients

A

17%

39
Q

What are the 4 major management areas for RA

A
  • Medications
  • Rehabilitation interventions
  • Lifestyle modification/self-management
  • surgery
40
Q

What are 5 types of medications for RA

A
  1. Traditional DMARD
  2. Biologiv DMARD
  3. NSAID
  4. Tylenol
  5. Corticosteroid
41
Q

Which medication is the first line of treatment

A

DMARD

42
Q

What are DMARDs used for

A

to halt the disease process - prevent irreversible joint damage

43
Q

What is the consequence of not using DMARD

A

premature death

44
Q

What is the downside to DMARDs

A

very expensive

45
Q

What is the target of treatment for people with a new RA diagnosis

A

Achieve and maintain remission

46
Q

What is the target of treatment for people with establish long-standing RA diagnosis

A

achieve and maintain low disease activity

47
Q

When is medication escalated

A

until the target is reached and promptly modified when the target is no longer

48
Q

Is typical or biological DMARD more effective

A

Biological

49
Q

What is the goal of rehabilitation interventions in the acute phase of RA

A

Control/decrease inflammation, control pain

50
Q

What are the modes of rehabilitation intervention in the acute phase

A
  • Balance rest & activity
  • ICe
  • Splints
  • ROM exercises
51
Q

Should you stretch an acutely inflamed joint? why?

A

No because the synovial membrane is already distended

52
Q

What are the goals of rehabilitation interventions in the chronic phase of RA

A
  1. Improve knowledge of RA and active self management
  2. Improve pain and stiffness
  3. Increase function & activity level
  4. Prevent deformity
  5. Address muscle imbalances
53
Q

What are the 4 Rs of surgical management

A
  • Remove - synovectomy, MTP resection
  • Re-align - tendon rupture repairs
  • Rest - Arthrodesis (surgical fusion) of the ankle, wrist, C1-C2
  • Replace - Arthroplasty hip, knee, ankle, shoulder, MCP joints

PHTH 565 RHEUMATOLOGY (7 decks)

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