Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis
chronic inflammatory systemic disease characterised by symmetrical deforming polyarthritis and extra-articular manifestations
what is the aetiology of RA
autoimmune basis
presenting symptoms of rheumatoid arthritis
GRADUAL onset,
joint pain, swelling, MORNING stiffness, impaired function
systemic symptoms; fever, fatigue and weight loss
what joints does RA mostly affect
peripheral joints symmetrically
symmetrical, polyarticular inflammatory arthritis involving the small joints of the hands (metacarpophalangeal and proximal interphalangeal joints), wrists, and feet
which joints are usually spared in RA
distal interphalangeal joints
Rheumatoid arthritis on examination
pain is inflammatory, worse in morning, better on movement, joints are swollen, red, warm and tender
what are some HAND deformities in rheumatoid arthritis
Wrist subluxation.
Metacarpophalangeal (MCP) subluxation.
Swan-neck finger deformity (MCP flexion, PIP hyperextension, DIP hyperflexion).
Boutonniere finger deformity (PIP flexion, DIP hyperextension).
Ulnar deviation of proximal phalanges.
Z-shaped thumb.
what are some FEET deformities
Hallux valgus.
Hammer toes.
MTP subluxation.
peri-articular features in RA
carpal tunnel syndrome
tenosynovitis
bursitis
haematological features
anaemia, splenomegaly, amyloidosis and generalised lymphadenopathy
dermatological features
rheumatoid nodules, small vessel vasculitis, raynauds syndrome
investigations for RA
bloods; FBC (anaemia), inflammatory markers (raised), Rheumatoid factor (present), Anti-CCP
joint X-ray (Soft tissue swelling
Periarticular osteoporosis.
Juxta-articular erosions.
Narrowing of joint space.)
blood tests findings RA
anaemia, inflammatory markers (raised CRP), rheumatoid factor and anti-CCP present
x-ray findings for RA
soft tissue swelling, erosions and narrowing of joint space
treatment of RA
Regular paracetamol and NSAIDs are the mainstay of reducing pain, swelling and stiffness. DMARDs may also be used
During flares, intra-articular or a course of oral steroids can be given.
Physiotherapy - exercise prescription to help maintain muscle strength around the joint and thus range of movement
Occupational therapy - provide advice and physical aids to avoid putting stress on joints during daily activities. Note - during acute flares, occupational therapists can also apply splints to joints.
Surgery is usually reserved for severely damaged joints and may include joint arthroplasty, fusion or synovectomy
