RA Clinical Aspects

Question 1

what is ra

Answer 1

A Chronic inflammatory polyarthritis characterized by morning stiffness with a symmetrical distribution often involving the hands

Question 2

genetic marker of ra

Answer 2

Shared epitope HLA-DR beta chains

Question 3

pathogenesis of ra

Answer 3

Autoimmune response with a self sustaining inflammatory reaction

Recruitment of Antigen Presenting Cells and T cells
- basically once you get sick, you cant really recover from it and its chornic

Question 4

ra pthogenesis starting with macrophages and T cells release cytokines

Answer 4

Some are pro-inflammatory (IL-1, TNF, IL-6)

T cells stimulate B cell differentiation into plasma cells

Plasma cells produce immunoglobulins (Rheumatoid
Factors) which forms immune complexes

Question 5

proinflmmatory cytokines

Answer 5

TNFα
IL-1
IL-6

Question 6

antinflammatory cytokines

Answer 6

IL-Ira
IL-4
IL-10
IL-11
IL-13

Question 7

what does the synovium leading to the Pannum lead to

Answer 7

Leads to bone resorption and erosion
Leads to cartilage destruction
Leads to ligamentous laxity

Question 8

pattern of onset for RA

Answer 8

Insidious onset over weeks to months (55-70%)
Constitutional symptoms-fatigue, malaise, low grade
fever
Commonly symmetric but can begin asymmetrically
Morning stiffness (at least half an hour to a couple
hours)
Acute Onset within a few days (8-15%)- may have better
prognosis
Intermediate Onset over weeks (15-20%)

Question 9

RA poorer prognostic signs

Answer 9

Earlier Age of Onset
Insidious onset
Rheumatoid nodules
High titer of Rheumatoid Factor, CCP antibody
Elevated Sed. Rate, thrombocytosis
Extra-articular Manifestations

Question 10

RA cervical spine

Answer 10

One of the few non-synovial joints (discovertebral joints) to be affected

Atlantoaxial (c1 & 2) Subluxation: anteriorly, posteriorly, and vertically

Can lead to a spastic quadriparesis, paresthesia in upper extremities

Lateral C Spine X-ray in flexion: greater than 3 mm of separation between odontoid peg and axial arch.

Question 11

RA shoulders

Answer 11

glenohumeral joint, distal third of clavicle, rotator cuff tears

Question 12

RA hands/wrist

Answer 12

Dorsal synovitis at wrist (Vaughan Jackson Deformity-cannot extend the 4th/5th fingers), Ulnar deviation and subluxation at MCPs, Swan neck, boutonniere, and thumb deformities, carpal tunnel syndrome, flexor tendonitis

Question 13

RA elbow

Answer 13

often lose complete extension

Question 14

some extrarticular dz of RA- hematological

Answer 14

Anemia of chronic disease (slight drop in H&H)
Thrombocytosis
Eosinophilia
*Felty’s Syndrome (triad (not common)-Splenomegaly, RA, Neutropenia) with associated infections and leg ulcerations

Question 15

what is feltys syndrome

Answer 15

(triad (not common)-Splenomegaly, RA, Neutropenia) with associated infections and leg ulcerations

Question 16

what do rheumatoid nodules almost always go along with

Answer 16

RF+ test

Question 17

is vasculitis in RA common

Answer 17

no

Question 18

is the kidney usually affected in RA

Answer 18

RARE