RA quiz 3 Flashcards
RA definition
Autoimmune disease w/predilection for synovial tissue &
associated tendon sheath
RA onset
May follow viruses, stress, surgery, infection, trauma, pregnancy
RA course
Highly variable
• 50% have progressive disease
• 3% have erosive arthritis
RA prognosis
Better in men than women. Patients >50 at time of onset have poorer prognosis • Poor prognosis =early age, high RF titer, high ESR, swelling>20joints & extracurricular manifestations
RA stages
- Disease present , asymptomatic
- Disease interfering w/ADLs
- Major compromise in function
- incapacitation, confine to bed or w/c
RA is a
autoimmune disease
RA cartilage loss is
symmetrical
RA HPI ask
- Location, duration & characteristics of pain.
- Tenderness, inflammation and morning stiffness
- systemic fatigue, associated symptoms
RA FH; ID genetic markers
Id
genetic markers for RA
(class 2 human leukocyte antigen {HLA} w/an identical 5-‐amino-‐acid sequence
RA History could sound like
- Am stiffness several hours
- Arthritis of 3 or more joints
- Arthritis of the hands ( Metacarpal)
- Symmetric arthritis
- Rheumatoid nodules
- RF
- Radiological changes
Diagnosis RA with
presence of 4-7 and 1-4 present for 6 weeks
2010 ACR/EULAR
score of >6/10 to classify as RA
RA Constitutional symptoms
fatigue
low grade fever
Malaise
wt. Loss
RA extra-articular symptoms
Sjogren’s syndrome, vasculitis, pulmonary nodules, Felty’s Syndrome (splenomegaly, anemia,thrombocytopenia)
RA S/S
soft tissue swelling and tenderness
spongy joints warm to touch/tender
gelling
RA need to preform a full and total PE T/F
True
Physical Findings with RA
Febrile • Soft tissue swelling • Muscle atrophy • Effusions • Decreased ROM • Decreased strength • Thickening of the volar aspect of the wrist • Symmetry in changes • Soft tissue nodules • Popliteal (Baker’s) cysts –\behind the knees
RA deformity of the neck
Swan neck
RA deformity of the fingers
Mallet and Boutonniere
RA diagnosis you need to R/O
Reiters, SLE, gouty/GN/ psoriatic arthritis,
lyme disease
acute rheumatic fever
RA what would you expect to see on the CBC
Mild to moderate anemia
RA whattype of anemia is present
normochromic, normocystic
RA what would you expect the ESR to be
elevated
RA the RF level
is elevated with
Age and progression of disease
RA the C- reactive protein level is
Elevated
Why would you draw a LFT with suspected RA
R/O hepatitis
RA synovial fluid aspiration is
> WBC, crystal search and C&S
RA X-rays help determine
early changes
Progression
detect damage after 3 years into the disease
Are wrist ankles and toes involved in RA
t/f
False
Best description RA presentation
symmetrical early Am stiffness
On an x-ray or MRi you would expect o see with RA
Joint erosions
Which of the following hemograms would be expected for a 46-year-old woman with poorly controlled RA?
Hg = 9.7 g/dL (12–14 g/dL); MCV = 87 fL (80–96 fL); reticulocytes = 0.8% (1%–2%).
Hg = 11.1 g/dL (12–14 g/dL); MCV = 66 fL (80–96 fL); reticulocytes = 0.8% (1%–2%).
Hg = 10.1 g/dL (12–14 g/dL); MCV = 103 fL (80–96 fL); reticulocytes = 1.2% (1%–2%).
Hg = 11.4 g/dL (12–14 g/dL); MCV = 84 fL (80–96 fL); reticulocytes = 2.3% (1%–2%).
Which of the following is not characteristic of rheumatoid arthritis (RA)?
It is more common in women at a 3:1 ratio.
B. Family history of autoimmune conditions often is reported.
C. Peak age for disease onset in individuals is age 50 to 70 years.
D. Wrists, ankles, and toes often are involved
5.
RA disease progression is typically evaluated using all of the following approaches except:
A. x-ray.
B. MRI.
C. echosonography.
D. ultrasound.
Which of the following tests is most specific to the diagnosis of RA? A. elevated levels of rheumatoid factor B. abnormally high ESR C. leukopenia D. positive ANA titer
A. elevated levels of rheumatoid factor
A 52-year-old woman has RA. She now presents with decreased tearing, "gritty"-feeling eyes, and a dry mouth. You consider a diagnosis of: systemic lupus erythematosus. B. vasculitis. C. Sjögren syndrome. D. scleroderma.
C. Sjögren syndrome.
X-rays will fail to show changes in affected joints in approximately what percent of patients with RA at disease onset?. 30% B. 50% C. 75% D. 95%
. 30%
B. 50%
C. 75%
D. 95%
Which test is specific to RA
elevated RF
Hemogram in RA
reveals Normocytic, normochromic
RA diagnostic test CBC
Mild to moderate anemia
RA Mild to moderate anemia is
Normochromic, normocytic
RA ESR
elevated
RA the C reactive protein is
elevated
