RA and Fibromyalgia Flashcards
Rhumatoid Arthritis definition
Chronic, systemic, inflammatory autoimmune disease
Symmetric , erosive synovitis of Peripheral joints
Can be associated with
Extra-articular manifestations
What is the difference between RA and OA?
RA systemic , bilateral joints, autoimmune , affects the synovial fluid, extra-articular , reversible i caught early
OA: may just be an issue on one side, wear and tear
RA is characterized by _____ and _____
Synovitis (inflammation of the synovium) and joint destruction
70 percent of patients develop joint damage /erosion within ___ years of the onset
2 years
33% of patients are work disabled at __ years
5
WHO functional classification RA
1-4
Class 1: symptom free when PA or rest
Class 2: no symptoms at rest, but normal activities cause discomfort and SOB
Class 3: no symptoms at rest but normal activities are greatly limited
Class 4: symptoms at rest
True or false , RA is present before the first symptoms
True
Etiology / risk factors for RA
Antigens
Genetic susceptibility
Pathophysiology of RA
Immune hyper activation cycle : no off signal
- Antigen (toxic /foreign substance)
- Synovial inflammation
- Cytokines (immune response) release by macrophages
- Cytokines induce fibroblasts - result inn bone destruction
Screening tool for inflammatory arthritis (RA)
- significant discomfort in squeezing MCP, MTP
- prescience of 3 or more swollen joints
- more than 1 hour of morning stiffness
Extra-articular manifestations
– Scleritis (red eyes) referral ASAP
– Rheumatoid nodules (bumps)
– Vasculitis (necrosis )
– Interstitial lung disease
– Pericardial disease
Poor prognostic factors of RA
earlier onset
female sex
polyarticular synovitis (>13 joints)
lab tests:
high titer Rheumatoid factor / anti CCP
elevated ESR rate or CRP level
HLA-DR4
erosion of cartilage loss on x ray in less than a year
poor functional status
extra-articular manidestations
HAQ
Health assessment questionnaire assesses ADL’s / fine motor and gross motor
RA joint manifestations
C spine: atlantoaxial subluxation due to laxity /rupture of transverse lig.
shoulder: H/AC joint , RTC and or bicep tendonitis/rupture,
elbow: nerve entrapment, olecranon bursitis
hip:bursitis, avascular necrosis
knee: quad atrophy, bakers cyst
Hand and wrist joint manifistatitons
MCP,PIP wrist synovitis
ulnar drift
swan neck, butonniere deformity
tenodynovitis
RA treatment
NSAIDS
multidisciplinary care
Steroid/glucocorticoids
Disease modifying drugs (start within 2-3 months of diagnosis
-immunosuppressive drugs
later: biologic therapies
Heath care maintenance RA
Osteoprosis: DEXA scans, calcium /vit D , Bisphosphonates (meds)
CVD: asses risk modiphy
Smoking cessation
Infection risk
Fibromyalgia Syndrome definition
chronic noninflammatory non autoimmune diffuse central pain processing syndrome
widespread pain, diffuse tenderness on exam, fatigue, depression, general somatic hyperawareness, cognitive problems, poor sleep
Demographic of FMS
young middle aged women
consider alternative diagnosis if male and >55
Secondary FMS
occurs with other conditions
ex: ppl with RA are at risk
FMS has an unknown cause / etiology but hypothesis supports
Genetic component
Functional MRI
CSF (substance P, inflammatory cytokines)
Pain experience with ppl with FM
FMS associated with lower pain threshold
innocuous pressure to healthy ppl evokes sig. less pain
can be seen on brain imaging
S & S FMS
pain from head to toe , everywhere
fatigue
difficulty falling asleep/non restorative sleep
depression n
physical examination and labs normal
Medical treatment for FMS
symptom based treatment
NON-pharmacological therapy is KEY
start slow go slow
exercise (aerobic is best, resistance )
pt , CBT
sleep
fatigue control
avoid opiods, NSAIDS don’t work
change one med at a time
target CENTRAL neurologic mechanisms
