Rheumatoid arthritis Flashcards
What is rheumatoid arthritis?
A chronic systemic inflammatory disease, characterised by potentially deforming symmetrical polyarthritis and extra-articular features
What joints are most commonly affected in RA?
Small joints of the hands and feet and the cervical spine
Larger joints such as the hips, knees, shoulders and elbows can also be affected
Which auto-antibodies can be used to aid diagnosis of RA?
Anti-CCP
Rheumatoid factor
Which blood tests might be abnormal in RA?
ESR and CRP are usually raised
What is the pathogenesis of RA?
Synovium becomes laden with macrophages, fibroblasts, and multi-nucleated giant cells Synovial membrane (pannus) expands and actively invades and erodes surrounding bone and cartilage As a result, there is less production of useful synovial fluid and the joint swells
What are the clinical features of RA?
Synovitis Morning stiffness Joint pain Joint deformity Systemic malaise e.g. fatigue
What is synovium?
Synovium lines joint capsules and is the metabolically active part of joints
What are some of the systemic manifestations of RA?
Scleritis Pleural effusion Anaemia of chronic illness Thrombocytosis Ischaemic heart disease
How does RA present radiologically?
Xrays tend to show a hypotrophic artritis (rather than the hypertrophic picture with OA) with loss of joint space but little or no osteophyte formation, sclerosis or bone cysts Periarticular erosions occur
What are ‘rheumatoid nodules’ and where do they occur?
Nodules consisting of areas of vasculitis and fibroblasts made from transformed macrophages
These tend to occur at pressure points
N.B. rheumatoid vasculitis tends to be benign
Why might ultrasound be useful in diagnosis or assessment of RA?
Can be used to identify synovitis that can’t be determined by palpation
What are some of the clinical signs of RA in the joints?
Swelling Tenderness Reduced range of movement Muscle wasting around affected joints Deformities in late stage of disease
Which genes are related to RA?
HLA DR4
HLA DR1
