Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis?
chronic autoimmune connective tissue disease that causes inflammation and deformity of synovial joints
What causes rheumatoid arthritis?
multifactoral:
- viral trigger? potentially EBV?
- genetic predisposition (HLA genes)
What is the pathology of rheumatoid arthritis?
- altered T cells target the synovial membrane and cause inflammation and joint damage
- altered B cells make antibodies called rheumatoid factors that target connective tissue (initially CT in joints but later, elsewhere)
- rheumatoid factors form immune complexes and deposit in synovial membranes and cause inflammation
- repeated inflammation leads to deformity of the joint
- pannus (vascular, granulation tissue) appears in the joint, it releases enzymes which destroy cartilage and has damaging inflammatory cells which decrease joint mobility
What are the manifestations of rheumatoid arthritis?
it affects joints and also other areas:
- subtle onset with first signs and symptoms being a low-grade fever and malaise
- this is followed by increased fatigue (this is the point where individual may seek healthcare)
- joint pain, especially in the morning
- stiffness after inactivity
- swan neck deformity and ulnar drift/shift in hand
other areas affected:
- heart, blood vessels, skin, lungs, eyes
How is rheumatoid arthritis diagnosed?
- history and presentation
- x-ray (won’t see anything in early stages)
- labs: exclude other stuff, look for rheumatoid factor (only found in 75% of cases), look for other self-antibodies (ANAs?, rule out SLE)
What are treatment goals for rheumatoid arthritis?
manage pain and limit disease progression
How is rheumatoid arthritis treated?
1) meloxicam (an NSAID) or naproxen with plaquenil (an antimalarial drug that is also an anti-inflammatory and has immuno-modulatory properties, but it can deposit in the eyes so get an eye exam every 6-12 months)
2) meloxicam AND sulfasalazine AND methotrexate (CBC, liver enzymes and creatinine monthly)
