rheumatoid arthritis . Flashcards
what sort of disorder is RA
autoimmune
what are the factors that play a role in development of RA
genetic predispositon
environmental (e.g. smoking or infection)
hormonal - higher incidence in females
describe the textbook RA pt
35-50, female
30 minutes of early morning stiffness in hands and feet
other autoimmune condition
what are the long term complications of RA
involvement of C spine - atlantoaxial compression -> spinal cord compression
describe symptomatic relief of RA
analgesics, NSAIDs, steriods
DMARDs - methotrexate first line
biologic - second line
when is a biologic tried instead of DMARD in RA
when 2 DMARDs have been tried with no response
what are the Ix used in suspected RA
bloods (inflammatory markers, rheumatoid factor or anti CCP)
X ray of hands and feet
USS
MRI
what are the blood test findings in RA
rasied inflammatory markers (CRP, plasma viscosity, ESR)
presence of rheumatoid factor or anti CCP antibodies - NOT PRESENT IN ALL PTS
what are X ray findings in RA
early disease - can be normal, may show soft tissue swelling andperiarticular osteopenia
late disease - erosions and subluxation
USS findings in RA
synovial inflammation
why would USS be used in RA
clinical uncertainty esp in early RA
useful in making treatment changes
why would you use MRI in RA
diagnostic doubt
very sensitive
what are the articular manifestations of RA
polyarthralgia - symmetrical pain and swelling of affected joints, rapid onset, small joints of hands and feet (MCPs, PIPs, MTPs), larger joints can be affected as disease progresses
early morning stiffness >30 mins that improves with activity
reduction in grip strength
deformities
atlantoaxial subluxation
describe the joint deformities found in RA
swan neck deformity - PIP hyperextension and DIP flexion
boutonniere deformity - PIP flexion and DIP hyperextension
describe the signs of RA
swelling of affected joints
positive compression tests of MCP and MTPs
bouchards nodes
rheumatoid nodules
synovial herniation - cysts
