Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis?
- disease of the synovial with gradual inflammatory joint destruction
What are the two different patterns of joint involvement in rheumatoid arthritis?
- seropositive rheumatoid arthritis
- rheumatoid factor present
- seronegative rheumatoid arthritis
- rheumatoid factor not present
How can the typical pattern of rheumatoid arthritis be described and what joints does it affect?
symmetrical polyarthritis affecting all synovial joints in the body (toes, ankles, knees, arms, shoulder, neck)
What are the symptoms of rheumatoid arthritis?
- slow onset
- starts with hands and feet
- proximal spread
- potentially all synovial structures
- symmetrical
- onset with systemic symptoms
- fatigue
- numbness and tingling
- weight loss
- anaemia
- joint swelling, stiffness and pain
What are the early signs of rheumatoid arthritis?
- symmetrical synovitis of metacarpal phalangeal joints
- symmetrical synovitis of proximal phalangeal joints
- symmetrical synovitis of the wrist joints
What are the late signs of rheumatoid arthritis?
- joint integrity is lost so direction is not controlled, movement is not restricted
- ulnar devotion of the fingers at the metacarpal phalangeal joint
- hyperextension of the proximal phalangeal joints
- “swan neck deformity”
- destruction of bone ends
- tendon pulls bone back further
- “Z” deformity of thumb
- hyperflexion of metacarpal joint
- hyperextension of proximal pharyngeal joints
- ‘boutonniere deformity)
- subluxation of wrist
- loss of abduction and external rotation of shoulders
- deformity of feet and ankles
What are the possible extra-articular features of rheumatoid arthritis?
- systemic vasculitis
- inflammation of blood vessels
- psoriasis
- more aggressive forms of rheumatoid arthritis
- usually younger patients
- ‘psoriatic’ arthritis
- eye involvement
- scleritis and episcleritis
- dry eyes
- Sjögren’s syndrome
- subcutaneous nodules
- pressure points
- amyloidosis
- amyloid produced as a result of synovial inflammation
- pulmonary inflammation
- neurological effects
What investigations are performed for rheumatoid arthritis and what do they look for?
- radiographs
- erosions
- loss of joint space
- deformity
- joint destruction
- secondary osteoarthritis
- blood
- normochromic normocytic anaemia
- CT and MRI
- joints
- increasingly used
How is rheumatoid arthritis treated?
- physiotherapy
- maintain current function and action
- occupational therapy
- maximise independent living
- drug therapy
- slow disease process
- reduce pain
- surgery
- replacement joints when stability is lost
- restoration of function
What is the aim of physiotherapy for rheumatoid arthritis and what does it involve?
- keep the patient active for as long as possible
- delay onset of debilitating disease
- active and passive exercise
- maintains muscle activity
- improves joint stability
- maintains joint position
What is the aim of occupational therapy for rheumatoid arthritis and what does it involve?
- maximising residual function
- providing aids to independent living
- assessment and alteration of home
- facilitating a safe and healthy life
- specialised utensils, wet room, stair lift etc.
What is the aim of drug therapy for rheumatoid arthritis in the majority of cases and what does it involve?
- pain relief and potential slow of disease progression
- analgesics
- paracetamol
- cocodamol
- NSAIDs
- often combined with anti-peptic ulcer disease agent
- disease modifying drugs
- hydroxychloroquine
- methotrexate
- used to slow immune process therefore damage to joints
- less commonly sulphasalazine, penacillamine, gold
- steroids
- intra-articular injections
- to target particular areas of inflammation
- common in early and moderate stages of disease
What is the aim of drug therapy for rheumatoid arthritis in moderate and severe cases and what does it involve?
- immune modulators
- azathioprine
- mycophenolate
- biologics
- TNF alpha inhibitors (infliximab, adalimumab, etanercept)
- leukocyte modulators (rituximab-CD20, tocilizumab-IL6r)
- steroids
- oral prednisolone
What is the aim of surgery for rheumatoid arthritis and what does it involve
- restoration of joint function
- excision of inflamed tissue
- inflamed synovial causes joint destruction
- joint replacement
- dysfunctional joint removed
- replaces with prosthetic joint
- joint fusion
- osteotomy
What is the prognosis for rheumatoid arthritis?
- 10% have spontaneous remit
- 90% have fluctuating course
- rheumatoid factor and late onset have worse prognosis
- 10% severely disabled
- 90% mild/moderate disability
- gets worse with time, can be slowed with medication
