Rheumatoid arthritis Flashcards
Presentation
Symmetrical deforming arthropathy of the small joints of the hands - proximal IPJ and MCP
Palmar subluxation and ulnar deviation
Rheumatoid nodules
Swan neck deformity
Hyperextension of PIP an flexion of DIP and MCP
Boutonniere’s deformity
Flexion at PIP and hyperextension at MCP and DIP
Z deformity
Thumb - flexion at IP joint and hyperextension at MCP
What tests can you perform to assess function in RA
Squeeze my fingers
Spread fingers
Hands on shoulders
Writing
Median nerve palsy
Wasting of thenar eminence, weakness of abductor pollicis brevis, decreased sensation over median border of hand
What are the symptoms of ulnar nerve palsy
wasting of hypothenar eminence, weakness of finger abduction, decreased sensation over ulnar border of the hand
Radial nerve palsy
Wrist drop, decreased sensation over first dorsal interosseous
What are the systemic symptoms of RA
Cervical spine - atlantoaxial subluxation
Eyes - episcleritis, scleritis, scleromalacia perforans
Anaemia
Lungs - pleural effusions, pulmonary fibrosis, bronchiectasis
Heart - pericarditis
Skin - pyoderma gangrenosum
Abdomen - splenomegaly
Kidneys - nephrotic syndrome
NS - mononeuritis multiplex
What is RF?
Ab against the Fc portion of the bodys own IgG - present in 70-75% of patients
Anti-CCP
90% specificity
Poor prognostic markers
RF +ve, anti CCP +ve, early erosive disease
Management
Patient education
Physio
OT
Bone protection
Vaccination
Drugs
Corticosteroids - to induce remission
DMARDs - sulfasalazine, methotrexate, leflunomide, azathioprine, hydroxychloroquine, ciclosporin
Biologics - Anti-TNF alpha - infliximab, adalimumab, etanercept
IL-1 receptor antagonist - anakinra
B cell depleting monoclonal Ab - rituximab
