RA SCHEMA Flashcards
1
Q
Important Aspect of Hx
A
- Familial Hx: Increased frequency among first degree relatives
- Age: Usually beings 3-4th decade (peak onset) (usually occurs in people between 25–55)
- Female (1.6):Male(1)
Usually insidious onset of - Fatigue
- loss of appetite & weight loss
- low-grade fever
-malaise (general lack of well being)
-morning stiffness>1 hour
-weakness
-widespread myalgia
2
Q
Early Manifestations
A
- Pain, swelling, warmth, stiffness and reduced ROM
- Affecting usually 2-3 joints symmetrically
- MCP and PIP joints of fingers are typically affected (+wrists, knees, ankles and feet)
3
Q
Established disease:
A
- Includes early manifestations as well as
More Joints affected
- Wrists (most frequent)
- Feet
- Knees
- Shoulders
- Cx spine affected in 1/3 of cases
Tenosynovitis
- Extensor compartments of wrists
- Flexor sheaths of fingers
- Tenderness of affected tendons
Brusitis &; Bakers cyst
4
Q
Advanced Phase manifestations:
A
Constant ache
Joint deformity (due to joint instability and tendon rupture) e.g.
- Ulnar deviation of fingers
- radial and palmar displacements of wrists
- Valgus knees
- Valgus feet
- clawed toes
Severly limited ROM in affected joints
5
Q
Extra-articular manifestations
A
- Pallor (anaemia)
- Pericarditis
- Vasculitis leading to haemorrhagic rashes
- Rheumatoid nodules (severe disease, over bony prominences)
- Neuropathy
6
Q
Diagnostic Criteria
A
- The more joints affected = more points
- Positive RF with high titres = more points
- Positive ESR and CRP = more points
- > 6 weeks = more points
- 6 points required for definite RA
7
Q
Observation
A
- Gait
- Deformity
8
Q
AROM
A
- Reduced ROM
- Pain
- Stiffness
- Crepitus
9
Q
PROM
A
- Reduced ROM
- Pain
- Stiffness
- Crepitus
(same as active) - Larger range of ROM
- Palpable crepitus
- Boggy end feel (maybe bone in severe destruction)
10
Q
Seg Def
A
- Often lost first
11
Q
Palpation
A
- Swollen
- Hot
- Tenderness of joint and periarticular tissue
12
Q
Extra tests
A
- Squeeze test
- Tinnels
- HR
