Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis?
- Most common form of autoimmune
arthritis - Acute and chronic inflammation primarily affects synovial joints
= Joint destruction
What is a proliferative synovial disease?
Joint destruction
What are causes of rheumatoid arthritis?
- Unknown triggers for immune response in synovial tissue
- Genetics
- Environmental triggers
- Hormonal changes
What is involved with genetic cause of rheumatoid arthritis?
Determines both risk and severity of disease
HLA-DR4
What are the environmental triggers of rheumatoid arthritis?
Bacterial antigens
- Mycobateria
- Streptococcus
- Mycoplasma
- E.coli
- H. pylori
Viral antigens
- EBV
- Rubella
- Parvovirus
- Smoking
What are the risk factors associated with rheumatoid arthritis?
Female Positive family history Older age Smoking Coffee consumption (> 3 cups daily)
Wat are the signs and symptoms of rheumatoid arthritis?
- Insidious onset affecting distal joints first
- Pain
- Morning stiffness
- Swelling and tenderness
- Systemic symptoms
- Nodules
- Pregnancy
What is the hallmark sign of rheumatoid arthritis?
Morning stiffness
- Gel phenomenon
- Lasting more than an 1 hr
- Decreases with physical activity
What happens in pregnancy with rheumatoid arthritis?
Clinical improvement and postpartum flares
What are the affected joints with RA?
Wrists MCP PIP - Flexor tendon tenosynovitis MTP Knees Elbows Ankles Hips Shoulder
What joints are typically spaired in rheumatoid arthritis?
Thoracolumbar spine
Finger DIPs
Toe IPs
What part of the spine is affected by rheumatoid arthritis?
C1-C2 articulation
What manifestations occur in hands with rheumatoid arthritis?
DIP joints almost never involved MCP ulnar deviation Swan-neck deformity Boutonnière deformity Nodules
What is included with felty’s syndrome?
RA
Splenomegaly
Neutropenia
***Severe RA disease
What are associated with felty’s syndrome?
Hepatomegaly
Thrombocytopenia
Lymphadenopathy
Fever
What is the diagnostic criteria for rheumatoid arthritis?
NEED 4 of 7
- Morning stiffness at least 1 hr
- Arthritis 3 or more joints
- Swelling of hand joints
- Symmetrical swelling (soft tissue)
- Rheumatoid nodules
- Positive serum rheumatoid factor
- Xray evidence of erosions &/or periarticular osteopenia in hand or wrist joints
***Stiffness and swelling must be at least 6 weeks
What labs are used in diagnostic rheumatoid arthritis?
RF ANA CBC w/diff CRP ESR Anti-CCP
What is Anti-CCP?
- Anti-cyclic citrullinated peptide antibody
- Prognostic value
What is the 2010 American College of Rheumatology diagnostic criteria?
Joint involvement
Serology
Duration of Synovitis
Acute phase reactants
What are the goals for treatment for rheumatoid arthritis?
Lifelong disease without cure
Remission
Patient education
Referral to Rheumatologist
What are the conservative options for rheumatoid arthritis?
Braces
Splints
Orthoses
Medications
What are the drug treatment options for rheumatoid arthritis?
NSAIDs
Low-dose prednisone
Intra-articular steroid injection
- Flares
What do disease modifying antirheumatic drugs (DMARDs) contribute to?
Target cytokines or receptors in inflammatory cascade
Decrease monoclonal antibodies
What are some examples of disease modifying antirheumatic drugs (DMARDs)?
Sulfasalazine
Hydroxychloroquine
Methotrexate/Leflunamide
Cyclophosphamide
What are examples of anti-TNF drugs?
Infliximab; etanercept
Adalimumab; golimumab
What is the surgical treatment of rheumatoid arthritis?
Joint replacement
Table of osteoarthritis.
Age
- Is a factor
Cause
- Joint wear
Symptoms
- Localized to affected joint
Structure
- Articular cartilage
Joint Changes
- “wear and tear”
Hands
- Heberdon nodes
- Bouchard nodes
- 1st MCM joint
Table of rheumatoid arthritis.
Age
- Is a factor
Cause
- Autoimmune
Family History
- Is a factor
Symptoms
- Joints and systemic
Structure
- Synovium
Joint Changes
- Joint destruction
Hands
- MCP ulnar deviation
- Swan-neck deformity
- Boutonnière deformity
