RA, OA and others Flashcards
What is rheumatoid arthritis?
Autoimmune disease (chronic, systemic, inflammatory disorder affecting whole body and not just joints) Primarily synovial joints tho Has extraarticular manifestations More women (35-50 YO)
Etiology of rheumatoid arthritis
Interaction betwwen genes (HLA) and environment
Progression of RA
External trigger causing autoimmune rxn and inflammatory process
Synovial hypetrophy and chronic joint inflammation
Destruction of joints (bones and cartilage are eroded)
Joint deformity
Clinical features of RA
Symmetrical polyarthritis
Progresses from periphery to more proximal
Usually spare axial skeleton (except C1/2)
Gradual onset with difficulty performing ADLs
May have constitutional features
Predominant sxs of RA
Pain, stiffness and swelling of mostly small joints of hands, wrists and forefoot (can be elbows, shoulders, ankles and knees)
Morning stiffness OVER 1 HOUR (gets better with movement)
What is spared in RA?
DIP joints
Physical findings in RA
TTP or movement of joint
Squeeze tenderness of MCP and MTP joints
Palpable synovial thickening (boggy)
Effusion (fluctuance)
What do the hands look like in RA?
Symmetrical inflammation of MCP and PIP
Flexor tendon tenosynovitis (decreased ROM/grip strength, trigger finger)
Swan neck and boutonniere deformities
Ulnar deviation/drift
What do the wrists look like in RA?
Loss of extension
Carpal tunnel syndrome (entrapment of nerve due to inflammation)
What do the elbows look like in RA?
Loss of extension
Ulnar nerve compression
Rheumatoid nodules most common here
What do the shoulders look like in RA?
Seen late in disease (because disease moves distal to proximal)
Frozen shoulder
What do the LEs look like in RA?
Feet/ankles: callus formation, hallux valgus (bunion), hammer toes, compensated flexion
Knees: effusion, limited ROM (flexion), Baker’s cyst
Hips: in longstanding disease there is restriction of movement
When is the cervical spine affected in RA?
Atlantoaxial joint instability (C1/2) due to chronic inflammation
Cervical subluxation causes neck pain, stiffness and radicular pain (radiating numbness/tingling associated with spinal nerves) that can lead to cervical myelopathy (pinch spinal cord)
What is the significance of extraarticular manifestations in RA?
Marker of disease severity (associated with increased morbidity and premature mortality)
Pts more likely to see this: hx of smoking, early onset of physical disability, test + for serum RF
Where can you see extraarticular manifestations in RA?
Skin (subcutaneous nodules), eye, pulmonary, cardiovascular (CAD), MSK, hematologic (anemia), CNS (aseptic meningitis)
Felty syndrome
Triad of RA, splenomegaly and neutropenia
What is seen in radiography for RA?
Preferred INITIAL imaging study
Soft tissue swelling around joint, periarticular osteopenia, joint space narrowing, bony erosions, subluxation
What is the use of MRI and US in RA?
More sensitive at detecting changes resulting from synovitis
MRI is valuable for assessing cervical spine
What lab studies do you do for RA?
RF, anti-cyclic citrullinated peptide antibodies, ANA (30%), CBC, ESR/CRP, synovial fluid analysis
What is RF?
First autoantibody associated with RA
Seen in 75-80% of RA pts (some point in disease)
Moderate specificity
Prognostic value
What are anti-CCP antibodies?
Autoantibody most specific for RA
Present in 60-70% pts
Specificity for RA is high
Correlate strongly with erosive disease
CBC in RA
See anemia of any chronic disease, thrombocytosis or mild leukocytosis (indicative of an inflammatory process)
Why would ESR/CRP be elevated in RA?
Parallels the activity of the disease so it would be high in an active flare
Why is an arthrocentesis used in RA?
Diagnosis of exclusion of gout, psuedogout or infection
Synovial fluid analysis can reveal an inflammatory effusion
