Rheumatoid Arthritis Flashcards
Onset of RA?
35-50 years
Higher prevalence in _______ population
aboriginal
RA is an _______ disease
autoimmune
In response to immunologic factors, ______ ______ become inflamed
synovial membranes
Synovial cell proliferation = ______
hyperplasia
First thing that happens in RA?
Synovitis
Increased __________ brings in a lot of inflammatory cells
vascularity
Articular damage is caused by _____
pannus
Pannus = _______ tissue formed within synovium
granulation
Inflammatory mediators such as ____ and ___ can cause joint damage
IL-6; TNF
Bone _____ can be effected if inflammation is not controlled
density (OP)
The pannus spreads over the articular cartilage and erodes the underlying _____ and _____.
cartilage; bone
Pannus may extend over time to the opposite articular surface creating _____ _____, _______ and ______.
scar tissue; adhesions; ankylosis
Bone becomes _____, ligaments and tendons are damaged or ruptured, and surrounding muscular _______ leaving the joints unstable and prone to _______.
osteopenic; deteriorate; deformity
Synovial cells become more _____ in the pannus.
fibrous
______ occurs at the end stage of the disease.
ankylosis
Familial hx of RA = overall increased risk by __x.
2x
RF is a genetic marker present in ___% of people with RA
80
RF accounts for about __% of the genetic risk for RA
30
There is elevated RF in __-__% of healthy persons > 60 yo.
5-10
High RF count cannot be used as a dx for RA as many other diseases can also have a high RF count. Name 4?
- lupus
- syphilis
- chronic hepatitis
- IPF
________ _______ = RF -ve and with clinical symptoms of RA
seronegative arthritis
Seronegative arthritis found in __% of patients
30
Increased risk of RA after ____ _____
child birth
Increased risk of RA after childbirth may be due to increased ______.
prolactin
Cigarette smoking ____ the risk of RA, esp. in (men/women)
increases; men
In terms of diet, decreased risk with consumption of what 3 things?
- olive oil
- fish (> 3 x per week)
- drinking tea (> 3 cups/day)
A dx of RA is made when >/= __/7 criteria are met
4
What are the 7 criteria for RA?
- morning stiffness > 1 hour (>/=6 weeks)
- arthritis of >/= 3 joints ((>/=6 weeks)
- arthritis of hand joints (>/=6 weeks)
- symmetric arthritis (>/=6 weeks)
- rheumatoid nodules
- serum rheumatoid factor +
- radiographic changes
RA often spares the ___ joint
DIP
What are 10 clinical features of RA?
- pain
- stiffness
- fatigue
- decreased ROM
- often involves small joints
- often symmetrical
- swelling
- joint deformity
- mm atrophy
- extraarticular features
________ use in individuals with RA can increase muscle atrophy.
corticosteroid
Nodules develop _______
subcutaneously
Nodules are occasionally found in ___ and ___ tissues, which = poorer prognosis
heart; lung
Rheumatoid nodules affects about ___% of patients at some point during the disease
30
Rheumatoid nodules occur (earlier/later) in the disease progress
later
Where are rheumatoid nodules typically found ?
elbow, fingers, wrist and hip joint, lower back, achilles tendon
Secondary Raynaud’s phenomenon is prevalent in __% of RA pt’s
17
Secondary Raynaud’s phenomenon caused by _______ in capillaries when exposed to cold or stress
vasospasm
4 management strategies in RA?
- meds
- rehab intereventions
- lifestyle modification / self-management
- sx
2 drugs that halt the disease process?
- traditional DMARD (disease modifying anti-rheumatic drugs)
- biologic DMARD
Most powerful fast acting anti-inflammatory ?
corticosteroid
First line rx in RA?
DMARD
DMARD should be used early and consistently to prevent ________ joint damage.
irreversible
Example of a DMARD?
methotrexate
What is the rehab goal in the acute phase of RA?
control/decrease inflammation, control pain
Do not stretch an acutely inflamed joint because the _____ ______ is already distended
synovial membrane
4 rehab interventions in the acute?
- balance rest and activity - energy conservation
- ice
- splints, positioning
- ROM exercises
5 rehab goals in the chronic phase?
- improve knowledge about RA and active self-management
- improve pain and stiffness
- improve function and activity level
- prevent deformity
- address muscle imbalance
4 rehab interventions to improve pain and stiffness in chronic phase?
- modalities
- positioning, supports, splints
- exercise - ROM, gentle strengthening
- energy conservation
____ prevention education is important in the chronic phase
falls
Those with RA should avoid a _____ lifestyle
sedentary
3 skills needed for self-management of RA?
- problem-solving
- self-monitoring
- communication
4 R’s in sx management of RA?
- Remove
- Re-align
- Rest
- Replace
Remove in terms of sx management?
synovectomy, MTP resection
Re-align in terms of sx management?
tendon rupture repairs
Rest in terms of sx management?
arthrodesis of the ankle, wrist, C1-C2
Replace in terms of sx management?
arthroplasty hip, knee, ankle, shoulder, MCP joints
Decreasing ____ and ____ are the most important goals from the patents perspective
pain; fatigue
