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#Phase 2.2: Acute Care > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is RA?

A

Chronic inflamm systemic symmetric autoimmune disorder

(pneumonic = CISSA disorder)

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2
Q

What is the relationship between RA and CV diseases?

A

Increases risk by 2-3x bc faster atherosclerosis

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3
Q

What is the cause of RA?

A

Unknown

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4
Q

What are the risk factors of RA? (3 things)

A
  1. Obesity
  2. Smoking
  3. Female (3:1)
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5
Q

What are the general clinical features of RA? (3 things)

A
  1. Symmetrical swelling
  2. Pain + pain on motion
  3. Morning stiffness
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6
Q

What is the difference between the EARLY and LATE signs of RA?

A 
Early = inflamm but NO joint damage 
Late = joint damage + deformities
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7
Q

What are the early signs of RA? (3 things)

A
  1. Swollen wrist, MCP, PIP, MTP
  2. Tenosynovitis (inflamm of synovium in tendon sheath)
  3. Bursitis
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8
Q

What are the late signs of RA? (4 things)

A
  1. Ulnar deviation of wrist
  2. Swan neck deformity (DIP)
  3. Boutonniere deformity (PIP)
  4. Hitchhiker thumb / Z deformity
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9
Q

What is a Swan neck deformity?

A

PIP hyperextension + DIP flexion

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10
Q

What is a Boutonniere deformity?

A

PIP flexion + DIP hyperextension

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11
Q

What is a Hitchhiker thumb / Z deformity deformity?

A

MCP flexion + IP hyperextension

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12
Q

What percentage of patients have Extra-articular manifestations of RA?

A

40%

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13
Q

What are the GENERAL Extra-articular manifestations of RA? (3 things)

A
  1. Fever
  2. Fatigue
  3. Weight loss
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14
Q

What are the NODULAR Extra-articular manifestations of RA? (4 things)

A

Nodes in:

  1. Elbows
  2. Lungs
  3. Heart
  4. CNS
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15
Q

What are the LUNGS Extra-articular manifestations of RA? (3 things)

A
  1. Pleural disease
  2. Interstitial fibrosis
  3. Organizing pneumonia
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16
Q

What are the CARDIAC Extra-articular manifestations of RA? (3 things)

A
  1. IHD
  2. Pericarditis
  3. Pericardial effusion
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17
Q

What are the NEURO Extra-articular manifestations of RA? (2 things)

A
  1. Carpel tunnel
  2. Peripheral neuropathy
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18
Q

What are the EYES Extra-articular manifestations of RA? (3 things)

A
  1. Episcleritis
  2. Scleritis
  3. Scleromalacia
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19
Q

What is an OTHER Extra-articular manifestations of RA?

A

Splenomegaly

20
Q

What investigations should be done for RA? (4 things)

A
  1. Serology
  2. Bloods
  3. Synovial fluid analysis
  4. Imaging
21
Q

What are the Serological investigations that should be done for sus RA? (2 things)

A
  1. RhF (rheumatoid factor) (+ve in 70% pt)
  2. anti-CCP (98% specificity)
22
Q

What are the Blood results of RA? (4 things)

A
  1. Low Hb (sign of anaemia of chronic disease)
  2. High platelets
  3. High ESR (inflamm marker)
  4. High CPR
23
Q

What are the results of Synovial fluid analysis of RA?

A
  1. Leukocytosis
  2. -ve gram stain
  3. -ve gram culture
  4. -ve for crystals
24
Q

What are the early XR findings of RA? (4 things)

A
  1. Could be normal
  2. Loss of joint space
  3. Juxta-articular osteopenia
  4. Soft-tissue swelling
25
What are the late XR findings of RA? (2 things)
1. Bony erosions 2. Subluxation (partial dislocation of joint)
26
What are MRI / CT scans better than XR for in RA?
For diagnosing synovitis
27
What are the diagnostic criteria for RA? (4 things)
``` A = Joint Swelling B = Serology C = Acute phase reactants D = Duration of symptoms ```
28
What is the points system for Joint Swelling for the diagnosis of RA?
1 large joint = 0 2-10 large joints = 1 1-3 small joints = 2 4-10 small joints = 3 10+ joints (at least 1 small) = 5
29
What is the points system for Serology for the diagnosis of RA?
-ve RF AND anti-CCP = 0 Low +ve RF OR anti-CCP = 2 High +ve RF OR anti-CCP = 3
30
What is the points system for Acute phase reactants for the diagnosis of RA?
Normal CPR AND ESR = 0 Abnormal CPR OR ESR = 1
31
What is the points system for Duration of symptoms for the diagnosis of RA?
Less than 6 weeks = 0 6 weeks + = 1
32
How many points from the points system are diagnostic of RA?
6 points
33
What are some differentials of sus RA? (2 things)
1. OA 2. Gout
34
How do you differentiate a diagnosis between OA and RA?
OA = -ve RF + anti-CCP
35
How do you differentiate a diagnosis between Gout and RA? (2 things)
1. Gout = monoarticular 2. Gout = has crystals in synovial fluid
36
What is the goal of management of RA?
Refer to rheumatologist to prevent deformity + permanent damage
37
What are the Conservative management options for RA? (3 things)
1. Physiotherapy 2. Occup therapy 3. Smoking cessation
38
What are the Acute exacerbation management options for RA? (2 things)
1. NSAIDs 2. Steroids (reduce Swelling)
39
What are the Long term management options for RA? (3 things)
DMARDs (for all patients)
40
What is the most common DMARD?
Methotrexate
41
What are the side fx of Methotrexate (DMARD)? (3 things)
1. Myelosuppression (reduced bone marrow activity) 2. Cirrhosis 3. Pneumonitis
42
What are the indications for surgery of RA? (2 things)
1. Severe damage 2. Limited function
43
What are the surgical options for RA? (3 things)
1. Joint replacement 2. Joint fusion 3. Synovectomy (removing synovium membrane that lines joint)
44
What are the benefits of surgery for RA? (3 things)
1. Relieve pain 2. Improve function 3. Prevent deformity
45
What are the risks of surgery for RA? (4 things)
1. Bleeding 2. Infection 3. DVT / PE 4. Loosening of prosthetic parts

#Phase 2.2: Acute Care (31 decks)

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