Rheumatoid Arthritis Flashcards
Rheumatoid arthritis is an autoimmune disorder whose main manifestation is in what types of joints?
multiple synovitis joints
Is RA more common in men or women?
women
What are the pathologic findings in a RA joint?
Chronic synovitis with the formation of a pannus
What is a pannus?
It is abnormal granulation tissue that erodes cartilage, bone, ligaments, and tendons
What are the characteristics of acute phase RA?
Effusion and warmth
What are the characteristics of late phase RA?
Fibrous ankylosis
RA has an _____ onset with vague periarticular pain or stiffness.
insidious
Stiffness associated with RA persists for at least __ minutes in the morning
30
What joints does RA typically affect?
- PIP joints of the fingers
- MCP joints
- wrists
- knees
- ankles
- MTP joints
What may also occur with RA?
Synovial cysts and rupture of tendons
Does RA affect the spine?
It can affect the neck, but spares the remainder of the spine. In advanced RA patients AA subluxation is possible, which leads to death (Important to keep in mind during surgery).
__% of patients have RA nodules
20
Where do RA nodules predominate?
- Bony prominences
- Bursae
- Tendon sheaths
- Lungs
- Sclerae
What type of ocular symptoms are seen in patients with advanced RA?
- Dryness of eyes, mouth and other mucous membranes
- Episcleritis
- Scleritis
- Scleromalacia
What are other symptoms associated with RA?
- Interstitial lung disease
- Pericarditis and pleural disease
- Small vessel vasculitis
- Necrotizing arteritis
- Felty syndrome
- Aortitis
Anti-CCP antibodies and Rheumatoid factor are present in __-__% of patients with established RA
70-80
Which lab finding is the most specific blood test for RA?
Anti-CCP antibodies
What percentage of RA patients have antinuclear antibodies (ANA)?
20%
When is an arthrocentesis required?
When a patient with RA has one joint inflamed out of proportion to the rest in order to detect septic arthritis
Of all laboratory tests, which is the most specific to RA?
imaging
What are some differential diagnoses of RA?
- Osteoarthritis
- CPPD arthritis
- Gouty arthritis
- Spondyloarthropathies
- Chronic Lyme disease
- Human parvovirus B 19 infection
- Hepatitis C
- SLE
- Polymyalgia rheumatica
- Rheumatic fever
- Cancers
What are the 3 objectives to treating RA?
- reduction of inflammation and pain
- preservation of function
- prevention of deformity
What type of pharmacologic intervention should be started ASAP?
Disease-modifying antirheumatic drugs (DMARDs)
What are often used as a “bridge” to reduce disease activity until the slower acting DMARDs take effect?
corticosteroids
What are the 6 types of synthetic DMARDs?
- Methotrexate
- Sulfasalazine
- Leflunomide
- Antimalarials
- Minocyline
- Tofacitinib
What are the 4 types of biologic DMARDs?
- Tumor Necrosis Factor Inhibitors
- Abatacept
- Rituximab
- Tocilizumab
As a general rule, DMARDs have greater efficacy when administered how?
in combination rather than when used individually
What is the most commonly used combination of DMARDs to treat RA?
methotrexate with one of the TNF inhibitors
What are the 5 most common deformities that occur in patients with RA?
- ulnar deviation of the fingers
- boutonnière deformity
- “swan-neck” deformity
- valgus deformity of the knee
- volar subluxation of the MTP joints
The excess mortality associated with rheumatoid arthritis is largely due to what?
cardiovascular disease that appears to be a result of deleterious effects of chronic systemic inflammation on the vascular system
What is essential for appropriate diagnosis and the timely introduction of effective therapy?
Early referral to a rheumatologist
