RA Flashcards
What are risk factors for RA? What gene is related?
Genetics- HLA-DRB1 genes - “shared epitope”
Female>>>male
Smoking
Incidence peaks between ages 25-55
What is the main target for autoimmune process in RA?
Synovial tissues.
Synovial proliferation results in what? What does this do?
Synovial proliferation forms a pannus. The pannus invades and destroys bone and cartilage.
What are the clinical manifestations in the joints for RA?
Usually an insidious onset with morning stiffness lasting more than 30 minutes or after prolonged IN-activity.
Symmetric swelling of many joints that are tender/painful.
What joints are most commonly affected in RA?
PIP, MCP, wrists, ankles, knees, MTP
______ deviation of the MCP is classic in RA
Ulnar
A swan neck deformity is?
Hyperextension of the PIP, and flexion of the DIP.
A boutonniere deformity is?
Flexion of the PIP, extension of the DIP.
What are some general symptoms that people with RA can present with?
Fatigue, weight loss, low-grade fever.
What are rheumatoid nodules? Where are they located?
These are firm, non-tender nodules located on the extensor surfaces (esp forearms) that are only found in those that are RF positive.
They may also be in the lungs, sclerae, and other tissues.
What vascular abnormality can people with RA have?
Vasculitis.
What are the ocular manifestations in RA?
Keratoconjunctivitis sicca (secondary Sjogren syndrome, could also include xerostomia)
Also can see scleritis, and scleromalacia
What kind of pulmonary manifestations arise in RA?
Plueritis
Pleural effusions
Rheumatoid nodules
Interstitial lung disease.
People with RA also have cardiac comorbidities. What are they?
CV disease due to chronic inflammation
Pericardial effusions
Pericarditis.
What is felty syndrome?
Splenomegaly
Neutropenia - asymptomatic or recurrent bacterial infections
RA - typically seropositive, erosive, and severe.
What is the most specific test for RA?
Anti-ccp antibodies.
What percentage of patients are seronegative in RA? What does this mean
15%
Means they don’t test positive for RF or CCP
What inflammation marker is typically elevated in RA?
Elevated ESR/CRP
TF - people with RA might have anemia, thrombocytosis, WBC on the normal end or more mild leukocytosis
True lol
Synovial fluid analysis in RA shows? What cell predominates?
Inflammatory effusion, leukoctyes usually 1500-25,000, PMNs predominate
What do initial radiographs show in RA? Where are the earliest changes?
Show soft tissue swelling, osteopenia around the joint
Earliest changes are in the wrists or feet.
Later in the disease process of RA, radiographs show what?
Joint space narrowing and erosions.
What do you need to make the diagnosis of RA?
Inflammatory arthritis in 3 or more joints
Positive RF and/or anti-CCP – if seronegative, can still diagnose RA if you excluded other causes and all other characteristics are met
Elevated ESR/CRP
Duration > 6 weeks
Excluded all others causes.
Treatment goals of RA?
Control pain and inflammation
Preserve function
Prevent deformity
Early diagnosis and inititation of DMARDs ( disease-modifying- antirheumatic drugs)
Rheumatologist involvement
Patients often need combinations of DMARDS -MTX + TNF inhibitor most common.
