Rheumatoid Arthritis Flashcards
What causes the AA subluxation in RA?
Tenosynovitis of the transverse ligament of C1
What is Caplan’s syndrome
Rheumatoid pneumoconiosis.
People who are RF+ and develop intrapulmonary nodules.
How much space in the AA joint is considered abnormal?
Greater than 2.5 to 3 mm
Which way does the wrist deviate in RA?
Radially
Mechanism of boutonniere deformity
Weakness or rupture of terminal portion of extensor hood (tendon or central slip) at the PIP joint
What do you not want to use to treat a patient with RA who has rheumatoid nodules?
Methotrexate because it may enhance the development of accelerate the development of rheumatoid nodules
What is most specific and sensitive lab test for RA and is correlated with aggressive disease?
CCP
What ocular problem can people with RA develop?
Keratoconjunctivitis Sicca (dry eye)
What are the 7 ACR classification criteria for RA? And how long do you need to have symptoms for?
Need to have 4/7 of the following for 6 weeks:
- Symmetric involvement of joints
- 3 or joints involved
- Hand joint involvement
- RF positive
- Morning stiffness
- Rheumatoid nodules
- Radiographic changes
How do the carpal bones deviate in RA?
The proximal row of the carpal bones deviate in the volar direction.
The distal row deviates in the dorsal direction.
What are the 2 safest DMARDs in terms of toxicity?
Hydroxychloroquine and sulfasalazine
What kind of anemia is seen on CBC in RA?
Hypochromic microcytic anemia
Classic triad of felty’s syndrome
RA, splenomegaly, leukopenia
How do you treat mild, moderate and severe RA?
Mild = NSAIDs and DMARD Moderate = NSAIDs, DMARD, Steroid, Biologics Severe = NSAIDs, 2 DMARDs, Steroid, biologics
Etanercept, Infliximab, and adalimumab are what class of DMARD?
Anti-TNF
Treatment of ulnar deviated MCPs
Ulnar deviation splint
Membrane of granulation tissue that covers the articular cartilage at joint margins
Pannus
Most common direction of AA subluxation in RA
Anterior AA subluxation
What is the pseudobenediction sign and what causes it?
Inability to fully extend the 4th and 5th digits due to extensor tendon rupture because of the ulna drifting upwards causing abrasion and tearing of the extensor tendons to the 4th and 5th digits.
How does the ulnar styloid deviate in RA?
Rotates dorsally creating a floating ulnar head
Which DMARD can cause retinopathy and other eye problems?
Hydroxychloroquine
What tendons are involved in dequervains
APL and EPB
Which DMARD inhibits protein kinase JAK?
Tofacitinib
What is the piano key sign?
Dorsally rotated ulnar styloid in RA creates an easily compressible elevated ulnar styloid
MHC allele associated with RA
HLA-DR4
Mechanism of swan neck deformity
Lax volar plate and contracture of finger muscles
Mechanism of ulnar deviation at MCP
Ruptureo of Radial retinaculum
What kind of exercises do people with RA do?
Isometric exercises
What are 3 most commonly used DMARDs in RA treatment
MTX
Hydroxychloroquine
Sulfasalazine
What cardiac problem can people with RA develop?
Pericarditis
Correlation between RF and severity of RA
RF+ = increased severity of disease
Protrusion acetabuli
Inward bulging of the acetabulum into pelvic cavity
Viscosity, WBC, PMN %, and color of synovial fluid testing in RA
Viscosity = low WBC = 1000 - 75000 PMN = >70% Color = transparent, cloudy
What oral problem can people with RA develop?
Xerostomia
