Rheumatoid Arthritis Flashcards
General Considerations
- Autoimmune Disorder
- More common in women
- Genetic Predisposition
- Can cause early deaths
Pathologic Findings
- Chronic Synovitis
- Pannus: abnormal granulation tissue
Pannus
Abnormal Granulation Tissue
-Healing process starts with this
Joint Symptoms
Predominant Symptoms
- Starts insidiously
- Hurts in the morning
- Notice swelling
- A lot of inflammation
- lasts for >30 minutes
- Symmetric Involvement
Common Joints Involved
- PIP
- Synovial Cyst
- Rupture of Tendon
- Spares spine except cervical spine
What should you do right away?
Get an X-Ray - don’t get sued
Rheumatoid Nodules
- seen in 20% of patients
- Seen around bursa, tendon sheaths, lungs, sclerae
- Rheumatoid factor in blood increased chance of nodules
Ocular Symptoms
- dryness of eyes, mouth and other mucous membranes
- inflammation of different parts of the eye (Episcleritis, scleritis)
- Scleromalacia from scleral nodule
Other organs that can be affected
- Lung
- Pericarditis and Pleural disease
- Small vessel vasculitis
- Necrotizing arteritis
- Felty Syndrome
- Aoritis
Interstitial lung disease
cough
progressive dyspnea
Small Vessel vasculitis
Tiny hemorrhagic infarcts in the nail folds or finger pulps
Felty Syndrome
RA (severe destructive arthritis) + splenomegaly + neutroopenia
Aortitis
Rare late complications
Cause aortic regurgitation or rupture
Most specific blood test for RA
Anti-CCP antibodies
Rheumatoid Factor Lab findings
- IgM antibody directed against the Fc fragment of IgG
- Present in 70-80% of patients with established RA
- Sensitivity of only 50% in early disease
- Seen in other autoimmune disease
- Chronic infections (Hep C, syphilis, sub-acute bacterial endocarditis, tuberculosis)
- prevalence of rheumatoid factor positivity also rises with age in healthy individuals
Other Lab Findings
20% have ANA
ESR and C-Reactive protein are elevated
Hypochromic normocytic anemia
Elevated platelet count
What is needed to diagnose superimposed septic arthritis?
Arthrocentesis
Warm, Tender, painful, affects ROM - what is this?
Septic Arthritis
