Rheumatoid Arthritis Flashcards
what is rheumatoid arthritis?
a chronic systemic inflammatory disease characterised by potentially deforming symmetrical polyarthritis & extra-articular features
what is the aetiology of RA?
genetic susceptibility
environmental triggers
cigarette smoking
infective?
what happens to the joint in RA?
- thickened invasive synovium
- more & thinner synovial fluid
what does the thickened invasive synovium release?
all sorts of cytokines into the synovial space
describe the pathology of the synovium in RA
becomes laden with macrophages, fibroblasts & multi-nucleated giant cells (resemble osteoclasts)
describe the pathology of the synovial membrane/pannus in RA
exapnds, actively invade & erodes surrounding bone & cartilage
where else in the surrounding of the joint can be affected by synovium changes
tendon sheath
what are the articular symptoms?
- joint pain
- stiffness, especially in the morning
- joint swelling due to the pannus
- general symptoms e.g. malaise, fatigue
what signs are you likely to see in RA?
- swelling
- tenderness
- reduced range of movement
- deformities??
- muscle wasting??
- nodules
describe a swan neck deformity
flexion at the DIPJ & hyperextensionn at PIPJ
describe boutonneire’s deformity
hyperextensoin at DIPJ & flexion at PIPJ
name the deformities commonly found in the hands
- ulnar deviation
- z-shaped thumb
- swan neck
- boutonneires
- dorsal wrist subluxation
what are the common manifestations in the eyes
- dry eye
- inflammation -> fibrosis of the lateral glands
- reduced tear production
- scleritis -> rupture
scleritis
inflammation of the tissue covering the sclera
what are the common lung manifestation
- pulmonary fibrosis
- pleural effusions
- interstitial lung disease
what are the common manifestations in the skin
- rheumatoid nodules
- blood stain rash
- skin vasculitis
what complications can occur of rheumatoid nodules
can ulcerate & become infected
feltey’s syndrome
anaemia with cytopaenia
what investigations would you do for suspected RA?
- anti-CCP
- inflammatory markers
- FBC for anaemia
what is the most specific test for RA?
anti-ccp
which inflammatory markers would you test & what would you expect to see?
PV, CRP
should be raised
why would you use an ultrasound?
look for synovitis in the joints
what are the late complications of RA?
infection
cervical myelopathy
interstitial lung disease
peripheral neuropathy
cervical myelopathy
atlanto-axial or sub-axial subluxation
which system in particular is opened up to risks in RA?
CVS
what should a newly diagnosed RA patient be prescribed as quickly as possible?
DMARDs with steroids to cover “lag phase”
what can be used if DMARDs don’t work?
biologics
