Rheumatoid Arthritis Flashcards
What is rheumatiod arthritis (RA).
A systemic chronic autoimmune disorder affecting the synovial joints with extra-articular manifestations.
It is characterized by a symmetrical, deforming, peripheral polyarthritis.
What is the prevalence of RA. (2)
1-3%.
increased prevalence in smokers
Who is at greater risk of developing RA.
Women are at greater risk than men.
2:1 women:men.
What is the peak age of onset of RA.
50-60.
What are the typical symptoms of RA. (10)
Joint pain exacerbated by movement.
Symmetrical swollen, painful and stiff small joints of the hands and feet.
Joint pain worse in the morning.
There may be large joint involvement.
Extra articular manifestations.
Systemic symptoms: fever (mild), anorexia, malaise, weight loss, lethargy.
What are the clinical signs of RA. (10)
Joints: swollen, warm, tender joints. Joint deformities: swan neck, boutonniere, subluxation. Lymphadenopathy. Splenomegaly. Rheumatoid nodules. Muscle weakness. Look for tenosynovitis or bursitis. Evidence of amyloidosis and vasculitis. Later: ulnar deviation of the fingers and dorsal wrist subluxation. Hand extensor tendons may rupture.
What are the possible joint deformities in RA. (3)
Swan neck.
Boutonniere.
Subluxation.
What is a swan neck deformity. (2)
Hyperextension at PIP.
Flexion deformity at DIP.
What is a boutonniere deformity. (2)
Hyperextension at DIP.
Flexion deformity at PIP.
What is the mnemonic to remember the diagnosis criteria for RA.
RF RISES.
How many criteria are needed to make a positive diagnosis of RA.
4 out of 7.
What are the criteria to make a positive diagnosis of RA. (7)
Rheumatoid factor. Finger/hand joint involvement. Rheumatoid nodules. Involvement of 3 or more joints. Stiffness- early morning. Erosions/decalcification on Xrays. Symmetrical arthritis.
What tests should be carried out if RA is suspected. (4)
Blood tests.
Immunological tests.
Synovial fluid tests.
Xrays.
What is seen in the blood of a patient with RA. (6)
ESR and CRP (indication of the degree of synovial inflammation).
Anaemia of chronic disease.
Low albumin (correlates directly with disease severity).
Neutropenia (in Felty’s syndrome).
High platelets.
What should be tested immunologically if RA is suspected. (2)
Rheumatoid factor (RhF, positive in 70%). Anti-CCP (cyclic citrullinated peptide) antibody (may be a better predictor of progression to erosive join disease than titres of RhF, anti-CCP is highly specific).
What is seen in the Xrays of a patient with RA. (6)
Soft tissue swelling. Joint space narrowing. Peri-articular osteoporosis. Bony erosions. Deformities. Atlanto-axial subluxation.
What is seen in the synovial fluid of a patient with RA. (2)
Raised WCC.
Raised protein.
What are the goals of treatment of RA. (3)
Pain relief.
Protection of remaining articular structure.
Maintenance of function.