Rheumatoid arthritis Flashcards
What is rheumatoid arthritis?
Chronic inflammatory autoimmune disease
What is the onset of rheumatoid arthritis?
Gradual onset over days to weeks
Who is more commonly affected by rheumatoid arthritis?
Females
How long does morning stiffness usually last in someone with rheumatoid arthritis?
More than 30 minutes
What is the main presentation of rheumatoid arthritis?
symmetrical, polyarticular inflammatory arthritis involving the small joints of the hands, wrists, and feet.
Which joints are usually spared in someone with rhuematoid arthritis?
Distal interphalangeal joints
What improves the pain of rheumatoid arthritis?
Movement
How does rheumatoid arthritis get worse?
Larger joints become affected
What test will be positive in someone with rheumatoid arthritis?
The squeeze test
What is the squeeze test?
Discomfort on squeezing across the metacarpal or metatarsal joints
What are the characteristic hand features of rheumatoid arthritis?
Wrist subluxation.
Metacarpophalangeal subluxation.
Swan-neck finger deformity
Boutonniere finger deformity
Ulnar deviation of proximal phalanges.
Z-shaped thumb.
What are the characteristic feet features of rheumatoid arthritis?
Hallux valgus.
Hammer toes.
MTP subluxation.
How else can rheumatoid arthritis present?
Acute onset with marked systemic disturbance
Relapsing/remitting monoarthritis of different large joints
Which part of the spine tends to be affected in someone with reumatoid arthritis?
The cervical spine- atlanto-axial joint (C1-C2).
How can the eyes be affected in someone with rheumatoid arthritis?
keratoconjunctivitis sicca (most common- dry eyes)
episcleritis (erythema) and scleritis (erythema and pain)
What are the early x-ray changes in someone presenting with rheumatoid arthritis?
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
What are the late x-ray changes in someone presenting with rhuematoid arthritis?
periarticular erosions
subluxation
What is the first line antibody test for patients with suspected rheumatoid arthritis?
Rheumatoid factor (RF)
What type of antibody is RF usually?
IgM
How can RF be detected?
Rose-Waaler test: sheep red cell agglutination
Latex agglutination test
What are high RF levels associated with?
Severe progressive disease
What other conditions are associated with a positive RF?
Felty’s syndrome
Sjogren’s syndrome
Infective endocarditis
SLE
What other antibody can be used in the diagnosis of rheumatoid arthritis?
Anti-cyclic citrullinated peptide antibody
What is the importance of anti-ccp antibody in the diagnosis of rheumatoid arthritis?
Detectable up to 10 years before the development of rheumatoid arthritis
