Rheumatoid Arthritis Flashcards
What is arthritis?
Recall the prevalence of self-reported arthritis in Australia.
Define RA and its consequences.
What is the primary manifestation of RA?
Synovitis => erosion of bone, cartilage, peri-articular structures
Recall the epidemiology of RA.
Recall the structural difference between normal and RA joints.
Mention the articular manifestations of RA.
- Morning Stifness
- Cardinal symptom
- Accumulation of fluid within inflamed tissues during sleep
- Dissipates as oedema, products of inflammation absorbed by lymphatics and venules - returned to the circulation by movement
- Gel phenomenon if inactive during day
- Pain
- Swelling
Recall the distribution of joint involvements in RA.
Recall the basic hand anatomy.
Recall the characteristic and mechanism of Boutonniere deformity.
Characterised by:
- fixed flexion deformity of the PIP joint
- Fixed hyperextension of the DIP joint
Mechanism:
- protrusion the PIP joint through its ruptured extensor tendon
Recall the mechanism of swan neck deformity.
How do you observe MCP swelling?
No hill and valleys between the knuckles.
What is subluxation?
Subluxation is an incomplete or partial dislocation of a joint.
Describe the mechanism of the Z deformity of the thumb.
Recall the radiographic features of RA wrist.
Recall again the typical hand deformities of RA.
Recall the basic foot anatomy.
In which part of the spine does RA affect?
Atlantoaxial Joint
Recall the ultrasonographic features of RA hand.
What would the Power Doppler mode in an ultrasound detect?
It detects blood flow.
Recall the MRI findings in RA hand.
Recall radiographic features of RA feet.
Recall the extra-articular manifestations of RA.
Mention examples of extra-articular manifestations of RA.
Rheumatoid nodules
- for positive rheumatoid CCP patients
- a central area of necrosis surrounded by a collagenous capsule
- Occurs at sites of pressure
- Signs of poorer prognosis - more aggressive treatment
Episcleritis
- Red eye - medical emergency
- Signs of rheumatoid arthritis
- Leads to scarring of eye - progressive sight loss
Scleromalacia
- erode collagen of the surface
- No treatment - effects on sight loss
How do diagnose pulmonary nodules in X-ray?
Pulmonary nodules could be either lymphoma caused by RA or smoking-related cancer. To determine usually a surgical biopsy would be done.
Describe the mechanism of digital vasculitis.
Spots of tissue necrosis due to swelling of joint compressing the blood vessel supplying the region.
Describe pyoderma gangrenosum.
Pyoderma gangrenosum is a rare, inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow (eroding soft tissue). Treatment includes cleaning the wound, remove necrotic tissue, and immune suppress the patients.
Recall the common articular manifestations of Hand Osteoarthritis.
Recall radiographic features of hand OA.
Recall the difference between RA and OA.
Recall the pattern of joint involvement of RA and OA.
