Rheumatoid Arthritis Flashcards
what is RA?
Rheumatoid arthritis is an autoimmune condition that causes chronic inflammation of the synovial lining of the joints, tendon sheaths and bursa.
how is
RA distributed?
- RA tends to be symmetrical and affects multiple joints – symmetrical polyarthritis.
- Inflammation of the tendons increases the risk of tendon rupture.
RF for RA?
- Three times more common in women than men, develops in middle age but can present at any age.
- FHx increases the risk of RA.
genetic associations for RA?
1) HLA DR4
2) HLA DR1
what antibodies might you see in RA?
- RF (in around 70% of patients)
- RF is an autoantibody that binds to the Fc portion of IgG antibody, this activates the immune system against the patients’ own IgG resulting in systemic inflammation.
- Anti-CCP
- Anti-citrullinated cyclic peptide (anti-CCP) are autoantibodies that are more sensitive and specific than RF.
- Anti-CCP can predate RA so can be used to predict if the patient will go on to develop RA.
how would an RA patient present?
- Symmetrical distal poly-arthropathy
- Pain
- Swelling
- Stiffness
- Onset can be very rapid or over months or years.
- Fatigue
- Weight loss
- Flu-like illness
- Muscle aches and weakness
- Pain will often get better after activity and worsens at rest.
what is palindromic rheumatism ?
- Self-limiting short episodes of inflammatory arthritis with joint pain, stuffness and swelling only affecting a few joints.
- These last 1-2 days and completely resolves
- Having positive RF and anti-CCP, it likely to progress to full RA.
which joints are commonly affected in RA?
Common joints affected
1) PIPs
2) MCPs
3) Wrist
4) Ankle
5) MTP joints
6) Cervical spine
7) Large joints can also be affected such as knee, hips and shoulders
what is antlantoaxial subluxation and why are we worried about this in RA patients?
- This occurs at the cervical spine.
- The axis (C1) and the odontoid peg shift with the atlas (C1).
- Caused by local synovitis and damage to the ligaments and bursa.
- Subluxation can cause spinal cord compression and is an emergency.
what signs would you expect in the hands of an RA patient?
Signs in the hands
- Z-shaped deformity of the thumb
- Swan neck deformity (hyperextension PIP with flexed DIP)
- Boutonniere deformity (hyperextended DIP with flexed PIP)
- Ulnar deviation
what extra-articular manifestations might you see in an RA patient ?
- PF with pulmonary nodules (Caplan’s syndrome).
- Bronchiolitis obliterans (inflammation causing small airway destruction)
- Felty’s syndrome (RA, neutropenia and splenomegaly).
- Secondary Sjorgen’s Syndrome (aka Sicca syndrome).
- Anaemia of chronic disease
- CVD
- Eye manifestations
- Rheumatoid nodules
- Lymphadenopathy
- Carpal tunnel syndrome
- Amyloidosis
what eye manifestations might you see in an RA patient?
- Scleritis
- Episcleritis
- Keratitis
- Keratoconjuctivitis sicca
- Cataracts
- Retinopathy
what changes would you see on x-ray for RA?
- Joint destruction and deformity
- Soft tissue swelling
- Periarticular osteopenia
- Bony erosions
when would you refer an RA patient?
- Referral for any patient with recurrent synovitis even with -ve RF and anti-CCP and inflammatory markers.
- Should be urgent if sx have been present for over 3 months.
what criteria is used to diagnose RA? what sorts of aspects do you look at as part of this criteria?
ACR/ELAR from 2010, patients are scored based on:
- Joints involved (small and more score more)
- Serology (RF and anti-CCP)
- Inflammatory markers (ESR and CRP)
- Duration of sx (more or less than 6 weeks)
- Scores are added up and if >/= 6, then diagnosis RA
