Rheumatoid Arthritis Flashcards
Incidence of rheumatoid arthritis?
Effects > 350,000 people in Britain
Occurs all over world in all ethnic groups
More women than men
Incidence increased with age
Commonly starts in 3rd and 4th decades
Weak genetic link
Environmental factors suggested as more common in rural areas.
Definition of rheumatoid arthritis
Chronic, systemic, inflammatory, destructive & deforming polyarthritis. Peripheral & symmetrical, as small joints (hands and feet) are involved symmetrically.
Cause of RA?
Obscure: current concepts -
Disease results from altered immune response
Persistent antigen - antibody stimulation in genetically predisposed individuals
Presentation and clinical features of RA
Insidious onset -joint pain, stiffness & symmetrical swelling
Small joints of fingers and toes affected but can spread to all joints - swelling
Less common are elbows hips and neck
Progress of Rheumatoid arthritis
20% always mild RA -causes few problems
Most people follow pattern of flare ups and remissions - damage occurs to joints during each flare up.
20% RA becomes worse, quickly
Pain, muscle spasm, progressive joint destruction, limitation of movement, joint instability, subluxation and deformity can occur
Management of RH
Rest during flare ups
Mobilise during remission
Aids and appliances
Other symptoms of RA
Anorexia, weight loss and lethargy
Can start as acute illness, with inflammation of many joints, pyrexia, sweating and general malaise.
Sometimes other organs affected eg eyes lungs but rarely heart.
Early treatment for rheumatoid arthritis?
Early DMARD (disease modifying anti-rheumatoid drug) therapy is important to maintain function and reduce later disability.
Sulphasalazine and methotrixate are current DMARDs of choice.
Early referral to rheumatologist.
Diagnosis of rheumatoid arthritis
Blood tests: Hb (haemaglobin), E.S.R/plasmaviscosity/ C-reactive protein(crp) all check for inflammatory process. (Inflammatory markers)
Rheumatoid factor
X-rays/MRI/Ultrasound
Treatment (Diagnosed RA)
Suppress active and progressive disease - drug therapy
Analgesics/ NSAIDs/ DMARDs/Corticosteroids
Conservation and restoration of function in affected joints
Combination of drugs/rest/physio/surgery.
Operative procedures for RA
Synovectomy - surgical removal of inflamed joint tissue (synovium)
Repair of structures ( ruptured tendons)
Salvage - destroyed joints can be replaced as young as 18
Arthrodesis - joint fusion
