Rheumatoid Arthritis Flashcards
What is the most common inflammatory disease?
How common is it?
RA
1% of all adults
Which gender does RA affect more frequently?
Women (2-3x more)
Etiology of RA
Unknown
Thought to be genetic, environmental, or autoimmune
What joints does RA affect?
Proximal interphalangeal/metacarpophalangeal joints of hands and feet
What joints does OA affect?
Weight bearing joints and distal interphalangeal joints
Phases of RA
Exacerbations and remissions
What is found in 70-80% of all patients with RA?
Circulating auto-antibodies aka rheumatoid factors
Effect of inflammatory cytokines in RA
Erosion of articular surfaces and destruction of adjoining cartilage, tendons, and ligaments
Rheumatoid factors effect on immune system
Immune assault
Rheumatoid factors effect on skeletal structures
Dislocation and dissolution of skeletal structures
Implications of deformed joints
Have no stability and minimal range of motion
What aspects of a joint are effected by RA?
- Cartilage
- Ligament
- Tendon
- Bone
What are the four TNF inhibitors used in RA?
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Adalimumab (Humira)
- Golimumab (Simponi)
Effects of RA on the heart
Aortic or mitral regurg
Pericardial effusion
What is included in Felty’s Syndrome?
- RA
- Splenomegaly
- Neutropenia
How is peripheral neuropathy most commonly manifested in RA?
Carpal tunnel
Effects of joint involvement in RA
- Limits ROM
- Severe pain
- Joint instability
- Crippling deformities
What are the 3 most important joints affected in RA?
- TMJ
- Cricoarytenoid
- Atlanto-axial
Effects of cricoarytenoid joint involvment in RA
Cricoarytenoid joints of larynx may be swollen, inflamed, or fixed in a position that obstructs flow
Mucosa may be friable
What percent of RA pts have sensation of foreign body?
17
What percent of RA patients have hoarsenss
15
What percent of RA pts have sensation of fullness
14
What percent of RA pts have dyspnea?
10
Effect of TMJ involvement in RA
Flexion contractures and soft tissue swelling may lead to marked limitation in ability to open jaw
May only be able to open mouth 1-2 cms
What percent of RA pts have TMJ involvement?
30-80%
Effects of extensive C-spine involvement in RA
- Instability
- Limited movment of neck
- Severe laryngeal deviation
Most common site of c-spine involvment in RA
C1-C2
What medications may RA pt be on that we need to ask about?
- NSAIDs
- Steroids
- Methotrexate
- TNF inhibitors
How to evaluate how advanced cervical spine involvement is?
MRI, c-spine xray
What RA patients need even more careful positioning?
Osteopnic and patients on steroids
What to assess for after extubation of RA patient?
Post-extubation laryngeal edema or stridor
How may eyes be effected in RA?
Dry eyes
Sjogren’s Syndrome
