Rheumatoid Arthritis Flashcards
Who is more likely to get it?
People in their 50/60s, women, smokers, FMH
What is the typical presentation of RA?
Symmetrical, painful, swollen, stiff small joints of the hands and feet, worse in the morning.
Larger joints may eventually become more involved
What other presentations may occur?
Sudden onset widespread disease, recurrent mono arthritis, systemic illness with extra-articular symptoms, recurrent soft tissue issues
What are the extra articular symptoms of RA?
Fatigue, fever, weight loss, pericarditis, pleurisy
What are the early signs of RA?
Swollen MCP, PIP, wrist or MTP. Look for tenosynovitis and bursitis
What are signs at late presentation?
Boutonnière deformity, swan neck deformity, ulnar deviation, dursL wrist subluxation
What are the extra articular affects of RA? Name 8…
Splenomegaly, nodules on elbows and lungs, vasculitis, fibrosis get alveolitis, obliterative bronchiolitis, pleural and pericardial effusion, raynauds carpal tunnel, peripheral neuropathy, scleritis, osteoporosis and amyloidosis
What investigations would you do?
RhF, anti CCPs!!!, FBCs, XRs
Why is anti-CCPs such a good test?
98% specific
What would you see from FBCs?
Raised platelets, raised CRP, raised ESR
What might XRs show?
Soft tissue swelling, synovitis (may use USS or MRI to detect this), osteopenia by joints, decreased joint space and erosions
How is RA diagnosed?
ACR Scoring system
What does the a-D scoring system include?
A= joint involvement (low points for large joints higher for multiple small up to 5 points) B= serology (-ve ACCP and RhF 0, low + both =2, high + both =3) C= CRP and ESR (normal =0, abnormal = 1) D= duration greater than 6 weeks = 1
How many points to be diagnostic?
6/10
What is the management?
Refer, measure disease severity with DAS28 (swelling at 28 joints), aim to get DAS28 to below 3, DMARDs, steroids for flare ups, physiotherapy, surgery, smoking cessation
