Rheumatoid Arthritis

Question 1

The onset of rheumatoid arthritis is

Answer 1

25-55 years old

can occur at any age

Question 2

Rheumatoid arthritis is more prevalent

Answer 2

in women

Question 3

The etiology of rheumatoid arthritis is

Answer 3

unknown but includes

environmental, heredity, viral/bacterial infection, and rheumatoid factors

Question 4

Describe the differences between osteoarthritis and rheumatoid arthritis

Answer 4

OA: 1. degenerative disease
2. morning stiffness lasting less than 30 minutes
3. asymmetrical 
4. cartilage loss
RA: 1. autoimmune disease
2. morning stiffness lasting more than 30 minutes
3. symmetrical
4. inflamed synovium

Question 5

Clinical manifestations of rheumatoid arthritis include

Answer 5

joint involvement
TMJ- synovitis, 45-75% involvement
Nerve entrapment- carpal tunnel syndrome

Question 6

Describe how rheumatoid arthritis involves joint involvement

Answer 6

most often affects hands, feet, and wrists

1. inflammation of synovial joint membrane
2. rapid division and growth of cells in the joint
3. release of osteolytic enzymes, collagenases, and proteases

Question 7

The atlantoaxial instability can cause

Answer 7

C1-C2 involvement- need to provide inline stabilization
atlanto-odontoid separation- can impinge on the spinal cord and cause neurological involvement
atlantoaxial subluxation- can decrease blood flow through vertebral arteries

Question 8

The cricoarytenoid joint is

Answer 8

impacted in 26-86% of patients with severe RA

may see vocal cord nodules or polyps, and may see an obstruction in a fixed position

Question 9

Involvement of the cricoarytenoid joint typically presents

Answer 9

without clinical symptoms

or may see hoarseness, pain with swallowing, stridor, or dyspnea

Question 10

Systemic involvement of RA involves

Answer 10

pulmonary, cardiac, eyes, and muscle

Question 11

Describe the pulmonary involvement of RA

Answer 11

pleural effusion, pneumonitis, pulmonary nodules

Question 12

Describe the cardiac involvement of RA

Answer 12

pericarditis, pericardial effusion, mitral/aortic regurgitation, conduction defects

Question 13

Describe the eye involvement of RA

Answer 13

destruction of lacrimal and salivary duct

Question 14

Describe the muscle involvement of RA

Answer 14

rheumatoid myositis- muscle weakness, necrosis, and atrophy

Question 15

The primary treatment of RA is

Answer 15

dependent on the severity of symptoms

Question 16

For mild to moderate RA symptoms the treatment is

Answer 16

joint immobilization, rest, corticosteroids, NSAIDs

Question 17

For severe RA symptoms the treatment is

Answer 17

surgical intervention

Question 18

The classes of drugs used to treat RA include

Answer 18

DMARDS- disease modifying antirheumatic drugs which work to decrease the body’s immune or inflammatory properties
Non-biologic- such as methotrexate (cornerstone of tx)
Biologic- TNF inhibitors, interleukin 1 receptor agonists, anti CD 20 monoclonal antibody

Question 19

The anesthetic considerations for RA include

Answer 19

Medications
Airway
Positioning
& spinal anesthesia

Question 20

The spinal anesthesia considerations for RA include

Answer 20

sensory, CSF is decreased so reduce dose d/t higher spread

Question 21

The positioning anesthesia considerations for RA include

Answer 21

padding

Question 22

The medication considerations for RA include

Answer 22

NSAIDs- platelet dysfunction, renal & liver damage

corticosteroids- HPA axis suppression–> may need steroid supplementation

Question 23

The airway considerations for RA include

Answer 23

TMJ can limit mouth opening
cervical spine- have inline stabilization
cricoarytenoid joint- may need smaller ETT