RA Pre-Lecture Flashcards
- ___ disease
- ___ joint involvement
- Most common systemic inflammatory disease
- chronic
- symmetrical
EPIDEMIOLOGY
Age
– Occurs at any age
– Onset is usually between ___ - ___ years
– Shortens lifespan by 3 to 18 years
Sex
– ___ > ___ (6:1 for ages 14-45)
Race
– No discrimination
- 30-50
- female, male
MHC
Major Histocompatibility Complex
HLA: Human Lymphocyte Antigen typing
– HLA-DR4
– HLA-DR1
TAKE HOME MESSAGE:
– Consider possibility of a ___ etiology/redisposition
genetic
RA Progression
over time
inflammation ___ and disability ___
- decreases
- increases
Prodromal Effects
- fatigue
- weakness
- loss of ___
- joint pain
- low grade ___
- stiffness + muscle ache -> joint ___
- appetite
- fever
- swelling
DIAGNOSTIC CRITERIA
- ___ involvement
- serology
- duration of symptoms
- ___ phase reactants
- diagnosed with RA if there is a score of __ or more
- joint
- acute
- 6
JOINT INVOLVEMENT
Most Common Joints:
- ___ , ___ , and ___
May Involve:
- Elbows
- Shoulders
- Hip
- Knees
- Ankles
- Feet
- Wrists
- Hands
EXTRA-ARTICULAR MANIFESTATIONS
- rheumatoid nodules
- vasculitis
- pulmonary
- ocular
- cardiac
- Felty’s
RHEUMATOID NODULES
Common: hands, elbows, forearms ( ___ points)
More common in ___ disease
20% of patients are affected
Asymptomatic = ___ intervention
- pressure
- erosive
- NO
VASCULITIS
Inflammation of small, superficial blood vessels
Depends upon duration of disease
Stasis ulcers
Infarction -> ____
necrosis
fingie turin black
PULMONARY
Pleural effusions
Pulmonary ___
Nodules
Rare: interstitial ___ or arteritis
- fibrosis
- pneumonitis
OCULAR
___ sicca
- Itchy, dry eyes + inflammation
- ___ Syndrome (KS + RA)
Inflammation: sclera, episclera, cornea
Nodules
- Keratoconjunctivitis
- Sjogrens
CARDIAC
Increased risk of CV ____
Pericarditis
___ abnormalities
Rare: myocarditis
- mortality
- mortalityConduction
FELTY’S
- ___ megaly
- Neutropenia
- Splenomegaly
Other EXTRA-ARTICULAR MANIFESTATIONS
Lymphadenopathy
___ disease (associated with treatment)
Thrombocytosis
Anemia
renal
LABORATORY INDICATORS
- Anemia
- Thrombocytosis
- ___
- ___
- RF
- Anti-CCP/ACPA
- ANA
- Joint ___
- Radiographic findings
- CRP
- ESR
- aspirations
ERYTHROCYTE SEDIMENTATION RATE (ESR)
- ___
- Normal = 0 – 20 mm/hr
- Elevated in RA (> 20)
- Non-specific
C- REACTIVE PROTEIN (CRP)
- Normal: 0.0 – 0.5 mg/dL
- positive -> > 0.5 mg/dL
- > 10 mg/dL can indicate ___
bacterial infection
RHEUMATOID FACTOR (RF)
- Antibody specific for ____
- Not all patients with RA diagnosis are RF+ (60-70% are RF+)
- IgM
ANTI-CCP/ACPA
- High ___
- Present ___ in disease
- Predictive value for erosive disease
- Marker of ___ prognosis
- specificity
- earlier
- poor
ANTINUCLEAR ANTIBODIES (ANA)
- Elevated titers suggest ___ disease
- More indicative of SLE
- Reported as a titer
- autoimmune
JOINT ASPIRATION
- ___
- WBC: 5,000 – 50,000/ mm3
- Glucose: normal to ___ compared to serum
- Turbid
- low
RADIOGRAPHIC CHANGES
- Joint space ___
- ___ of bone
- narrowing
- erosions
POOR PROGNOSIS
PHYSICAL FACTORS
- Extra-articular manifestations
- Elevated ___ and ___
- High titers of ___
- Elevated ___ / ___
- Erosions on X-Ray
- Duration of disease
- Swelling of > ___ joints
- ESR, CRP
- RF
- anti-CCP/ACPA
- 20
DIFFERENCES FROM OA
RA
- any age
- systemic involvement
- ESR: elevated
- inflammation: present
- joint involvement: ___ : symmetric
- am stiffness > ___
- osteophyte: absent
___: often present
- RF: frequently positive
- subcutaneous nodules: frequently present
- swelling: diffuse symmetric
- malaise, fatigue, musculoskeletal pain, fever
- bilateral
- 1 hour
- pannus
PHARMACOLOGIC TREATMENT
(5)
NSAIDs
Corticosteroids
DMARDs
Biologic Agents Anti-TNF
Biologic Agents Non-TNF
