Rheumatoid arthritis Flashcards

1
Q

Define rheumatoid arthritis

A

Chronic inflammatory systemic disease characterised by symmetrical deforming polyarthritis & extra articular manifestations

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2
Q

Aetiology of rheumatoid arthritis

3

A

AUTOIMMUNE disease
UNKNOWN cause
Associated w/ other autoimmune disease (e.g. Sjogren’s syndrome)

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3
Q

HLA association of rheumatoid arthritis

2

A

HLA-DR1

HLA-DR4

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4
Q

Epidemiology of rheumatoid arthritis

prevalence x2, gender, age

A

COMMON
1% general population
3x more common in females
Peak incidence 30-50 yrs

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5
Q

Presenting symptoms of rheumatoid arthritis

6

A
Gradual onset
Joint pain
Swelling
Morning stiffness
Impaired function 
Usually affects peripheral joints symmetrically
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6
Q

Presenting symptoms of rheumatoid arthritis - systemic

3

A

Fever
Fatigue
Weight loss

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7
Q

Signs of rheumatoid arthritis on physical examination

general + 2 groups

A

Arthritis - most common in the HANDS

Early signs
Late signs

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8
Q

Signs of rheumatoid arthritis on physical examination - early
(4)

A

Spindling of fingers
Swelling of MCP & PIP joints
Warm, tender joints
Reduction in range of movement

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9
Q

Signs of rheumatoid arthritis on physical examination - late

7

A

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

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10
Q

Define subluxation

A

partial dislocation

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11
Q

Investigations for rheumatoid arthritis

3 types

A

Bloods
Joint aspiration
Joint xray

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12
Q

Investigations for rheumatoid arthritis - bloods

4

A

FBC - low Hb, high platelets
High ESR & CRP
Rheumatoid factor (found in 70% patients)
Antinuclear antibodies (30%)

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13
Q

Investigations for rheumatoid arthritis - joint aspiration

A

May be performed in acute setting to rule out septic arthritis

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14
Q

Investigations for rheumatoid arthritis - joint X-ray

4

A
(DONS)
Deformity
Osteopenia
Narrowing of joint space
Soft tissue swelling
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15
Q
Boutonniere deformity
(5)
A
Z deformity of thumb
Trigger finger (inability to straighten finger, tendon nodule palpable)
Tendon rupture
Wasting of small muscles of hand
Palmar erythema
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16
Q

Rheumatoid nodules

describe + location

A

Firm subcutaneous nodules

Usually found on elbows, ulnar margin, palms & over extensor tendons