Rheumatoid arthritis Flashcards
what is RA?
autoimmune condition
chronic inflammation of synovial lining of joints, tendon sheath and bursa
synovial inflammation
synovitis
joint distribution
symmetrical
multiple joints
women or men?
3x more women
genetic associations
HLA DR4
HLA DR1
Antibodies
RF
Anti-CCP
RF
autoantibody in 70% RA
targets Fc portion of IgG
Anti-CCP
autoantibodies - more sensitive and specific than RA
common presentation
symmetrical distal polyarthropathy
pain, stiffness, swelling
joints commonly affected
small joints of hands and feet
wrist, ankle, MCP, PIP
elbow, knee, shoulder
systemic symptoms
fatigue, weight loss, flu lie, muscle ache
RA vs OA pain
Pain RA worse after rest, better with activity
OA opposite
DIP affected?
NO
heberdens nodes
complication which can occur in spine
atlantoaxial subluxation
axis and odontoid peg
spinal cord compression
how do the joints feel?
boggy
4 key hand findings
ulnar deviation MCP
swan neck deformity
z deformity of thumb
boutonnieres deformity
swan neck deformity
hyperextended PIP with flexed DIP
boutonnieres deformity
hyperextended DIP with flexed PIP
tear in central slip of extensor compartment
Extra-articular manifestations
pulmonary fibrosis secondary sjogrens feltys syndrome anaemia chronic disease carpal tunnel syndrome amyloidosis bronchiolitis obliterans
feltys syndrome
RA
splenomegaly
neutropenia
investigations
clinical examination
check RF, Anti-CCP
CRP, ESR
x-ray of hands and feet
use of USS
evaluate and confirm synovitis
x-ray changes
Joint destruction and deformity
soft tissue swelling
periarticular osteopenia
bony erosions
ACR diagnostic criteria
joints involved - more and smaller
serology - RF, anti CCP
inflammatory markers
duration <6 weeks
