RA, Seronegative Athropathies and Gout Flashcards
If a patient presents with SYMMETRICAL arthritis, what should you be thinking?
RA
What are some systemic symptoms with RA and what markers are elevated?
Fatigue Fever Myalgia Anemia -- Elevated ESR/CRP
What genetic marker is RA associated with?
HLA-DR4
Describe the pathophysiology of RA
- Joint changes precede synovitis
- Infiltration of inflammatory cells activates T cells
- B cells produce autoantibodies and cytokines
- Pannus invades cartilage and bone
Describe the pathophysiology of RA
- Joint changes precede synovitis
- Infiltration of inflammatory cells active T cells
- B cells produce autoantibodies and cytokines
- Pannus destroys cartilage and bone
An RA score greater than ___/10 indicates RA
> 6/10
Where do articular manifestations start with RA?
Hands/feet and C1-C2 (not axial spine)
Why should you not flex the neck of RA patients?
C1-C2 may sublux
What finger deformities are associated with RA?
Swan-neck
Boutonniere
Ulnar deviation
When will RA patients have stiffness?
Morning stiffness > 1 year
Pyoderma Gangrenosum
– Can be seen with RA
= Tender purple papule –> necrotic non-healing ulcer
Rheumatoid Vasculitis
– Can be seen with RA
= Digital infarct
Patients with RA have an increased risk of what?
Heart manifestations – CAD
What other autoimmune disease that affect the secretions of the eye/mouth/vagina can occur with RA?
Sjogren’s Syndrome
Spondyloarthropathies are disorders that share clinical features and have (-)?
(-) serum markers
What HLA is often associated with the Spondylarthropathies?
HLA-B27
What HLA is often associated with the Spondylarthropathies?
HLA-B27
What locations in the body do Spondylarthropathies often affect?
Spine
SI joint
What are 4 Spondyloarthropathies?
Ankylosing Spondylitis
Reactive Arthritis
Psoriatic Arthritis
Enteropathic Arthritis
What are the symptoms of Ankylosing Spondylitis?
Low back pain
Decreased mobility
Plantar Fasciitis (heel pain)
What test can be used to assess the lumbar spinal immobility with Ankylosing Spondylitis?
Schober test
– restricted forward flexion
Besides restricted forward flexion of the spine, what else will be seen on physical exam with Ankylosing Spondylitis?
Decreased chest expansion
How will the vertebrae look with Ankylosing Spondylitis?
Squaring and shiny corners (sclerosis)
What are Syndesmophytes and what are they seen with?
Bony bridges between vertebrae that cause ankylosis (fusion)
– seen with Ankylosing Spondylitis
