Rheumatoid Arthritis Flashcards
What is the definition of rheumatoid arthritis?
Chronic, systemic, inflammatory autoimmune disease of unknown etiology
What is the distinctive feature of rheumatoid arthritis?
Chronic, symmetric, and erosive synovitis of peripheral joints
What are possible negative effects of untreated rheumatoid arthritis?
joint destruction, deformity, disability, and premature death
What is Phase 1 of RA?
Genetic risk - individual has genes that give one susceptibility to RA
What is Phase 2 of RA?
Preclinical Autoimmunity, brought on by an unknown environmental event
RF and/or anti-CCP may be present, also possibly autoreactive T cells
What is Phase 3 of RA?
Clinical disease - Clinical signs and symptoms
RF, anti-CCP, Radiographic changes,?Pathogenic T cells
What are possible RA antigens?
Viruses: retroviruses, EBV, parvovirus
Mycoplasma
Heat shock proteins, cartilage antigens, citrullinated peptides
What is the pathophysiology of RA (simplified from slides)?
Unknown antigen activates/injures synovium
Synovial inflammation and hypertrophy
Systemic symptoms
Cartilage and bone destruction
What is pannus?
Inflamed synovium
What are the categories for the ACR criteria for RA?
Joint Involvement
Serology
Acute Phase Reactants
Duration of Symptoms
What is the threshold score for definite RA according to the ACR criteria for RA?
> = 6/10, definite RA
How is joint involvement scored on the ACR criteria for RA?
1 large joint (0)
2-10 large joints (1)
1-3 small joints with or without large joints (2)
4-10 small joints with or without large joints (3)
>10 joints with at least 1 small joint (5)
How is serology scored on the ACR criteria for RA?
Negative RF and negative ACPA (0)
Low-positive RF or low-positive ACPA (2)
High-positive RF or high-positive ACPA (3)
How is “Acute Phase Reactants” scored on the ACR criteria for RA?
Normal CRP and normal ESR (0)
Abnormal CRP or abnormal ESR (1)
How is duration of sx scored on the ACR criteria for RA?
< 6 weeks (0); ≥ 6 weeks (1)
What are the tests on the Screening Tool for Inflammatory Arthritis (RA) in Primary Care?
Significant discomfort with squeezing the MCP and MTP joints
Presence of 3 or more swollen joints
More than 1 hour of morning stiffness
What are important elements of the history in the initial evaluation of a patient with RA?
Degree of joint pain Duration of morning stiffness Presence or absence of fatigue Limitation of function: mobility, personal care, special hand functions, work and recreation Poor sleep patterns Weight loss
What are important elements of the physical exam in the initial evaluation of a patient with RA?
Joint count of actively inflamed joints Mechanical joint problems: Loss of motion Crepitus Instability Malalignment Deformity
What are possible extraarticular manifestations in RA
Rheumatoid nodules Sjögren’s syndrome Episcleritis or scleritis Interstitial lung disease Pericardial disease Systemic vasculitis Felty’s syndrome
What are important laboratory and radiology tests in the initial evaluation of a patient with RA?
Rheumatoid factor: IgM against Fc of IgG Anti-CCP ESR or CRP CBC, electrolytes, creatinine Liver injury tests (LFTs) Synovial fluid analysis Urinalysis Stool guaiacs Radiographs of hands and/or feet
Which is more specific to RA, RF or anti-CCP?
Anti-CCP?
True or false, the presence of RF with anti-CCP are associated with a higher probability of joint damage and disability
True
What are poor prognostic indicators for an individual with RA?
Earlier age at onset; female sex
Polyarticular synovitis (>13 joints)
High titer rheumatoid factor and/or anti-CCP
Elevated ESR or CRP level
Erosions or cartilage loss on x-ray (in < 1 yr)
HLA-DR4 or “shared epitope”
Poor functional status (HAQ >1 at 1 yr disease)
Extraarticular manifestations: rheumatoid nodules, scleritis, ILD, pericarditis, vasculitis
In an individual with RA, how can the C spine become involved?
Atlantoaxial (C1-C2) subluxation due to laxity/rupture of the transverse ligament or fracture or erosion of the odontoid process
Symptoms: asymptomatic; cervical/occipital pain; cord impingement
