Rheumatoid Arthritis Flashcards
RA affects __% of the world population.
RA affects 1% of the world population.
Main target of inflammation in RA
The synovium
RA is more common in ___.
RA is more common in women (3:1 ratio).
Citrullination
a post-translational modification of proteins in which arginine residues are converted to citrulline—occurs at sites of inflammation
antibodies against citrullinated epitopes are found to be present in __% of patients with rheumatoid arthritis
antibodies against citrullinated epitopes are found to be present in 70% of patients with rheumatoid arthritis.
Thus, RA seems to be associated with a loss of tolerance to citrullinated proteins
Early presentations of rheumatoid arthritis
- Very, very gradual rise in polyarticular inflammation over years in many
- Some start with gradual mono- or oligo-articular arthritis which progresses to polyarticular in its full form
- Rarely, extra-articular symptoms of the rheumatoid arthritis syndrome, such as sclerosis, may present before the arthritic symptoms
- Low-grade fever common and significant weight loss may occur in early disease
Pattern of joint involvement for RA
- Smaller joints tend to be first, particularly the PIP, MCP, and MTP
- Larger joints like elbow and knee occur later
- Stiffness for >30 minutes in the morning, usually ~1.5-2 hours
Common first complaints for RA
- “My rings no longer fit”
- “The balls of my feet hurt when I walk to the bathroom in the morning”
- “My fingers and wrist hurt when I brush my teeth in the morning”
- “I run my hands in warm water to get them working”
Joints involved in Rheumatoid Arthritis
Only involvement of the spine in RA
C1-C2 articulation, trouble turning head
___ are involved with almost all patients with RA
hands are involved with almost all patients with RA
Radiographic findings of RA
Evidence of articular damage after months to years
Bone erosion
___ and/or ___ may confirm the presence of synovitis years before findings are possible with X-rays
Ultrasound and/or MRI may confirm the presence of synovitis years before findings are possible with X-rays
Signs in late, established RA
- Ulnar deviation of fingers at MCPs
- “Swan neck” deformities -> hyperextension of the PIP joints and flexion at the DIP joints
- “Buttonhole” deformities -> flexion of the PIP joints and hyperextension of the DIP joints
- Rheumatoid nodules -> soft to firm nodular lesions in various shapes from pea- sized to golf ball
Swan neck deformity in RA
Buttonhole deformity
Swan neck vs buttonhole deformity
___ may resemble rheumatoid nodules
Gouty tophi may resemble rheumatoid nodules
Distinctions include:
- tophi tend to be firm, nodules are fleshy
- tophi have a pale yellowish tinge and nodules have no specific coloration pattern
- There is no material that can be aspirated (using a needle) from a rheumatoid nodule, while a tophus yields toothpaste like material that under polarizing microscopy shows negatively birefringent needle shaped crystals.
Eroded PIP in RA patient
RA and carpal tunnel
Early in the course of the disease, synovial proliferation in and around the wrists can compress the median nerve, causing carpal tunnel syndrome
RA is symmetric with respect to . . .
. . . both the joint involvement and the compartmental involvement
In the case of the knee the medial and lateral compartments are both severely narrowed in RA, whereas OA usually involves only one compartment
___ can dramatically improve function and quality of life and should be considered in patients with severe mechanical damage
Total joint replacements of hips and knees can dramatically improve function and quality of life and should be considered in patients with severe mechanical damage
Unilateral loss of cartilage in osteoarthritis
Bilateral loss of cartilage in RA
