Rheumatoid Arthritis

Question 1

General Information and Epidemiology

Answer 1

Autoimmune disorder
Prevalence in 1%
F:M ration 3:1
One of the leading causes of disability

Question 2

Risk Factors

Answer 2

Age
Sex
Genetic predisposition
Obesity
Smoking
Nulliparous (never given birth)
Post-partum
Never taken BC

Question 3

Pathophysiology

Answer 3

Increase in T cells
Increase in TNF-alpha
Increase in Interleukins
Increase in B-cells (auto immune dysfunction)
= RANKL-osteopenia

Question 4

Joint Involvement

Answer 4

Pannus Formation
Subchondral bone erosion
Symmetrical
Bilateral

Question 5

Lab Findings

Answer 5

No specific test is diagnostic
RF tiger (can have an increase without RA)
ACPA (auto immmune, early sign!)
SED rate
ESR or CRP levels (systemic inflammation)

Question 6

Who should be tested?

Answer 6

People who have at least 1 joint with definite clinical synovitis
Synovitis cannot be explained by any other disease

Question 7

Classification Sections

Answer 7

Joint involvement (large and small joints)
Serology (RF and ACPA)
Acute phase reactants (CRP)
Duration of symptoms

Question 8

Prognosis

Answer 8

Poorer:
Younger age at onset
Early bony erosions
Swelling: more than 20 joints at diagnosis; more than 30 joints at diagnosis, early mortality
High RF level
High ESR

Better:
•Early ID and start on DMARDs within 3–5 months

Question 9

Extra-Articular Findings

Answer 9

Cardiac and smoking
Pulmonary and smoking
Neurologic
Vasculitis
Psychologic
Sarcopenia and osteopenia
Nodulosis (also known as rheumatoid nodules)

Question 10

Clinical Findings

Answer 10

Initially: flu like
Common joint signs and symptoms (stiffness for hours, redness, warmth, swelling)
Rheumatoid cachexia
Cardiovascular deconditioning

Question 11

Common deformities

Answer 11

Swan neck and boutonnières
Ulnar drift at MCP
Radial drift at radio carpal joint

Question 12

Management

Answer 12

NSAIDS
Glucocorticoids
DMARDs
Rehab concerns: DMARD toxicity, NSAIDs
Osteprotegrin: anti-osteoclasts

Question 13

Surgical Management

Answer 13

Synovectomy
Arthroplasty
Arthrodesis

Question 14

PT Assessment

Answer 14

Function scales
Assess pain
ROM
Muscle strength
Dynamic stability
CV endurance
Physical performance measures

Question 15

PT Management

Answer 15

Interdisciplinary approach
Education
Self management and support
Strength training
Cardio
Long term land base aerobic and muscle strengthening exercise