Rheumatoid arthritis Flashcards
Define rheumatoid arthritis
Chronic inflammatory systemic disease characterised by symmetrical deforming polyarthritis & extra articular manifestations
Aetiology of rheumatoid arthritis
3
AUTOIMMUNE disease
UNKNOWN cause
Associated w/ other autoimmune disease (e.g. Sjogren’s syndrome)
HLA association of rheumatoid arthritis
2
HLA-DR1
HLA-DR4
Epidemiology of rheumatoid arthritis
prevalence x2, gender, age
COMMON
1% general population
3x more common in females
Peak incidence 30-50 yrs
Presenting symptoms of rheumatoid arthritis
6
Gradual onset Joint pain Swelling Morning stiffness Impaired function Usually affects peripheral joints symmetrically
Presenting symptoms of rheumatoid arthritis - systemic
3
Fever
Fatigue
Weight loss
Signs of rheumatoid arthritis on physical examination
general + 2 groups
Arthritis - most common in the HANDS
Early signs
Late signs
Signs of rheumatoid arthritis on physical examination - early
(4)
Spindling of fingers
Swelling of MCP & PIP joints
Warm, tender joints
Reduction in range of movement
Signs of rheumatoid arthritis on physical examination - late
7
Symmetrical deforming arthropathy
Ulnar deviation of fingers as a result of subluxation of MCP joints
Radial deviation of wrist
Swan neck deformity
Boutonniere deformity
Rheumatoid nodules
Signs of complications
Define subluxation
partial dislocation
Investigations for rheumatoid arthritis
3 types
Bloods
Joint aspiration
Joint xray
Investigations for rheumatoid arthritis - bloods
4
FBC - low Hb, high platelets
High ESR & CRP
Rheumatoid factor (found in 70% patients)
Antinuclear antibodies (30%)
Investigations for rheumatoid arthritis - joint aspiration
May be performed in acute setting to rule out septic arthritis
Investigations for rheumatoid arthritis - joint X-ray
4
(DONS) Deformity Osteopenia Narrowing of joint space Soft tissue swelling
Boutonniere deformity (5)
Z deformity of thumb Trigger finger (inability to straighten finger, tendon nodule palpable) Tendon rupture Wasting of small muscles of hand Palmar erythema