rheumatoid arthritis Flashcards
what is rheumatoid arthritis initially?
disease of synovium with gradual inflammatory joint destruction
what is the difference between sero positive RA and sero negative RA?
sero positive RA - rheumatoid factor (autoantibody) is present
sero negative RA - rheumatoid factor is NOT present
what is the most common serious joint disease ?
rheumatoid arthritis
which sex does RA affect most?
female - peaks 20-50yrs
what joints are affected by RA?
all synovial joints
symmetrical poly arthritis
what are the symptoms of RA?
joint stiffness
joint pain
morning stiffness
fatigue
minor joint swelling
systemic symptoms - fever, weight loss, anaemia
describe the onset of RA
slow onset
initially hands and feet then potentially spreads to all synovial structures - symmetrical poly arthritis
what are the early signs of RA
symmetrical synovitis of MCP (metacarpal phalangeal) joints
symmetrical synovitis of PIP (proximal interphalangeal) joint
symmetrical synovitis of wrist joint
what are the late signs of RA on hands?
ulnar deviation of fingers at MCP joints
hyperextension of PIP joints
z deformity of thumb - hyperflexion of MCP
subluxation of wrist
what are the late signs of RA on elbows, shoulders, knees and feet?
loss of abduction and external rotation of shoulders
flexion of elbows and knees
deformity of feet and ankles
how do you investigate RA?
radiographs - show erosions, loss of joint space, deformity
blood tests - show normochromic normocytic anaemia due to failure of RBC stimulation
how is RA treated?
improve quality of life
physiotherapy
occupational therapy
drug therapy
surgery
what is the aim of physiotherapy?
keep patient active for as long as possible
maintain muscle activity and joint position
what is the aim of occupational therapy?
maximise residual function
provide aids to independent living e.g. stair lift
what drugs are used to treat RA in most cases?
analgesics for pain relief - paracetamol, NSAIDS, cocodomol
disease modifying drugs to slow down immune response and damage to joints e.g. methotrexate
steroids intra-articular
what drugs are used to treat RA in moderate and severe cases?
immune modulators - azathioprine, TNF inhibitors
steroids - oral prednisolone
what surgeries can treat RA?
joint replacement
joint fusion
osteotomy
excision of inflamed tissue
what percentage of RA patients spontaneously remit?
10%
what percentage of RA sufferers become severely disabled?
10%
what are the dental aspects of RA?
trouble accessing care
trouble with OH as reduced dexterity
associated with sjrogens syndrome as RA part of autoimmune disease process - dry mouth and increased caries risk
infection risk
chronic anaemia - GA issues
bleeding if taking NSAIDS
ulceration from methotrexate
what autoimmune disease is associated with Atlanto-occipital instability?
rheumatoid athritis
name three seronegative spondyloarthritides
ankylosing spondylitis - spinal joint arthritis
Reiter’s disease
Arthritis of inflammatory bowel disease
in ankylosing spondylitis, fusion of facet joints of vertebrae leads to what?
patient can’t turn twist or bend
HLA-B27 is associated with which disease?
ankylosing spondylitis
