Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis?
Initially a disease of the synovium with gradual inflammatory joint destruction
Patterns of joint involvement in rheumatoid arthritis
sero-positive RA
- rheumatoid factor present
sero-negative RA
- rheumatoid factor not present
Rheumatoid arthritis prevalence
most common serious joint disease
- 1%
- 6.1% female pre menopause
- 3.1% female post menopause
Rheumatoid arthritis peak age
20-50 years
Rheumatoid arthritis - symptoms
slow onset
- initially hands and feet
- proximal spread
- potentially all synovial structures
symmetrical poly arthritis
occasional onset with systemic symptoms
- fever, weight loss, anaemia
Rheumatoid arthritis - early signs
- symmetrical synovitis of MCP joints
- symmetrical synovitis of PIP joints
- symmetrical synovitis of wrist joints
Rheumatoid arthritis - late signs
ulnar deviation of fingers at MCP joints
hyperextension of PIP joints
- “swan neck” deformity
“z” deformation of thumb
- hyperflexion of MCP
- hyperextension of IP joint
subluxation of the wrist
loss of abduction and external rotation of shoulders
flexion of elbows and knees
deformity of feet and ankles
extra articular features of RA
inflammation of blood vessels
- due to systemic vasculitis
psoriasis in some patients
- gives more aggressive form of RA and in younger patients
- ‘psoriatic arthritis’
eye involvement
- dry eyes, Sjorgrens syndrome
- scleritis and episcleritis
- pulmonary inflammation
Rheumatoid arthritis - investigations
radiographs
- erosions, loss of joint space, deformity
- joint destruction and secondary osteoarthritis
blood
- normochromic, normocytic anaemia
rheumatoid arthritis - treatment
aim to improve quality of life
combinations of:
- physiotherapy
- occupational therapy
- drug therapy
- surgery
aims of physiotherapy when treating rheumatoid arthritis
keep patient active for as long as possible
active and passive exercises to:
- maintain muscle activity
- improve joint stability
- maintain joint position
aims of occupational therapy when treating rheumatoid arthritis
maximising residual function
providing aids to independent living
assessment and alteration at home
Drug therapy for rheumatoid arthritis
analgesics
- paracetamol, cocodamol
NSAIDs
- often combined with anti-PUD agents
Disease modifying drugs
- hydroxychloroquine, methotrexate
steroids
- intra-articular
Drug therapy in moderate and severe cases of RA
immune modulators
- azathioprine
- mycophenolate
- biologics - TNF inhibitors such as infliximab, adalimumab
steroids
- oral prednisolone
Rheumatoid arthritis - surgery
- excision of inflamed tissue
- joint replacement
- joint fusion
- osteotomy
*patients often have a poor medical condition for surgery
RA - prognosis
10% spontaneously remit
- remainder have fluctuating course
RF and late onset = worse prognosis
10% severely disabled
- remainder have mild/moderate disability
Rheumatoid arthritis complications
- peptic ulcer disease - NSAIDs
- infection
- extra-articular
- Drugs
Rheumatoid arthritis dental aspects
disability from the disease
- reduced dexterity
- access to care
sjorgrens syndrome
- dry mouth
joint replacements
drug effects
- bleeding - NSAIDs
- infection risk - steroids, azathioprine
- oral lichenoid reactions - hydroxycloroquine
- oral ulceration - methotrexate
- oral pigmentation - hydroxycloroquine
Ankylosing spondylitis prevalence
95% have HLA-B27
- 10% caucasians have HLA-B27
- 0.5% of these get ankylosing spondylitis
8:1 male predominance
onset about 20 years - rare after 45 years
20% also have large joint disease
Ankylosing spondylitis effects
disabling progressive lack of axial movement
symmetrical other joint involvement -e.g. hips
results in:
- lower back pain
- limited back and neck movement - restriction of turning spine
- limited chest expansion - compromised breathing
- cervical spine tipped forward restricting movement
ankylosing spondylitis treatment
generally same as rheumatoid arthritis
- analgesia and NSAIDs
- physiotherapy
- occupational therapy
- DMDs
- immune modulators
- surgery where appropriate for joint replacement
Ankylosing spondylitis dental aspects
GA hazardous
- limited mouth opening
- limited neck flexion
TMj involvement possible but rare except in psoriatic arthritis
