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MSK 2 Post Midterm > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What type of disease is RA?

What does it target?

A
  • Autoimmune, chronic systemic
  • Inflammatory disease, symmetrical
  • Targets synovial tissues, diarthrodial joints
  • Polyarthritis, extra-articular features
  • Idiopathic
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2
Q

Systemic features of RA

  • systemic sx
  • non specific labs
  • constitutional sx
A

• Fatigue, fever, anemia
• Elevated acute phase reactants (ESR, CRP)
• Constitutional symptoms – malaise, myalgia,
depression
• Affected joints are swollen, warm and tender over PIP and MCP joints

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3
Q

Immunopathology/pathogenesis of RA (two)

A
  • RF produced by RA synovium. RF’s fix complement. Complement consumed in RA joint; recruit PMN’s.
  • Anti-cyclic citrullinated peptides
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4
Q

“B” lymphocytes produce autoantibodies, cytokines (TNF alpha, IL-1, IL6), pro-inflammatory cytokines synovial proliferation, increase synovial fluid, leads to ___ that invades cartilage and bone.

A

leads to pannus in RA

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5
Q

Lab tests to order for RA dx

A
  • ESR/CRP
  • RF
  • ACCP
  • ANA
  • Hepatitis panel
  • CBC
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6
Q

What two imaging tests should be ordered in RA - to detect what?

A

EROSION DETECTION!
• X-rays of hands and feet – detect symmetrical involvement of MCP/MTP joints; erosions
• CT – more sensitive detecting erosions

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7
Q

4 treatment progressions of RA

A
  • Begin NSAID for pain control
  • Early use of DMARD
  • May need low dose of steroid for a few weeks
  • Monitor progress and toxicity
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8
Q

Three types of Rheumatoid Synovitis

A

Bursitis, tendinitis, synovitis

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9
Q

Significant cause of mortality in RA

A

! Heart disease (60%) - CAD, HF, pericarditis due to endothelial damage from chronic inflammation !

  • Malignancy (20%)
  • Infection (9.4%)
  • Renal disease (7.8%)
  • GI disease (4%)
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10
Q

Who should be tested for RA? Classification criteria

What is definite RA?

A
  1. Have at least one (1) joint with definite clinical synovitis
  2. With synovitis not better explained by another disease

A score > 6/10 = definite RA

Serology + APR + Duration of Symptoms

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11
Q

Describe articular manifestations of RA.

A
  • Typically starts in hands/feet (MCP, PIP, MTP)

- Later = larger joints, wrists, knees, elbows, ankles, hips, shoulders

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12
Q

Part of spine that is affected by RA

A

C1-C2

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13
Q

define swan neck and boutonniere

A

• Swan neck (hyperextension of PIP joints)
• Boutonniere (button hole
deformity) (hyperflexion of PIP joints)

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14
Q

Rheumatoid nodules = RF+/-?

A

RF+ always

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15
Q

Baker cysts

A

RF nodules in knee/popliteal

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16
Q

**Describe clinical manifestations of RA - describe the PE of joints, what type of joints, what time of day? Is this abrupt or insidious?

A
  • Pain, swelling, warmth in multiple small joints (less than 3) of hands and/or feet
  • Morning stiffness greater than one (1) year
  • Less than 10% have abrupt onset of disease
17
Q

**Dx of RA is active signs of inflammation for at least __ weeks.

A

six

18
Q

**Extra-Articular Manifestations of RA

  • more common in what type of RA patient
  • what are the manifestations?
A
  • More common in RF positive or Anti-CCP positive

* Skin – subcutaneous nodules; extensor surface of forearm

19
Q

What is this:

Tender reddish purple papule; leads to necrotic, non-healing ulcer

A

pyoderm gangrenosum

20
Q

What is this:

Purpura, petechial, splinter hemorrhages, digital infarct

A

Rheumatoid vasculitis

21
Q

What is RA + pneumoconiosis + pulm nodules?
CXR hyperlucency.

What is it due to?

A

Felty Syndrome. Nodular densities after exposure to coal or silica dust.

22
Q

What is keratoconjuctivitis sicca?

A

Extra-articular manifestation of RA due to a secondary Sjogrens Syndrome or SLE (Dry eyes)

  • dry eyes, damage to eye surface
  • dry mouth, increased tooth decay
23
Q

Tests for Sjogrens

A
  • Ro/SS-a, La/SS-B (both associated with salivary gland involvement)
  • Schirmers test (tear test)
  • Slit-lamp exam
24
Q

Tx for Sjogren’s Syndrome

A

Anti – Inflammatory &

Immunosuppressive

25
Q

What is:
• RA
• Splenomegalia
• Neutropenia/anemia/thrombocytopenia

A

Feltys Syndrome

26
Q

While there is NO SINGLE finding on PE or lab that is pathogneumonic, describe lab findings in RA

A
  • RF positive
  • Anti-CCP antibody (remember – 15%-20% of RA patients are negative for these antibodies)
  • Inc. ESR or CRP parallels activity of disease
  • Anemia (NC-NC, chronic)
  • Thrombocytosis (acute phase reactant)
  • ANA+ (30% of RA patients)
  • Hyperglobulinemia
  • Leukopenia / Granulocytopenia
  • Low glucose in body fluids
  • Synovial fluid – 2/3 PMN’s; WBC’s 5000 – 100,000/mm3
27
Q

Tx of RA
Non-biologic DMARDs
Biologic DMARDs
(which can be used in pregnancy?)

A

No cure - treat early and to keep in remission; PT/OT

DMARD + bridging therapy (NSAIDs, then CS)

Non-biologic DMARDs:

  • *PREG? YES, then use **antimalarial (hydrochlorquine) and sulfasalazine
  • *PREG? NO, then use MTX, leflunomide (pyrimidine antag)

Biologic DMARDs:
(immunosuppressants etanercept, infliximab, adalimumab, rituximab)

-ANALGESICS are necessary to control pain

28
Q

**Define progression of RA management

A
  • Define extent of joint and extra-articular involvement
  • Full dose of NSAID
  • Early use of DMARD
  • Add a biologic agent
  • Low does steroids – flares/bridge
  • Adequate pain management
  • Monitor progress/toxicity
29
Q

RA is MC secondary cause of what?

A

Sjogren’s (anti-SSA/B, speckled)

MSK 2 Post Midterm (11 decks)

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