Rheumatoid arthritis Flashcards
what type of disease is rheumatoid arthritis(RA)
autoimmune chronic inflammatory
when does rheumatoid arthritis typically present
in the 2nd to 4th decades
describe the proportion of females to males in rheumatoid arthritis
3 female: 1male
describe the general systemic features of rheumatoid arthritis
malaise, fever and generalised musculo-skeletal pain
describe the effect that rheumatoid arthritis has on the joints
swollen, warm, painful, limited movement in morning and after inactivity
what joints are usually effected by rheumatoid arthritis
small joints before large joints
hands and feet, then wrists , ankles, elbows, knees, cervical spine
what joints are usually spared in rheumatoid arthritis
hips and lumbosacral joints
describe some features of rheumatoid arthritis progression
joint fusion(ankylosis), limited ROM, synovial herniation, joint effusions, loss of articular cartilage
describe the genetic factors linked to rheumatoid arthritis(RA)
HLA DR4 mediated
describe some environmental factors linked to rheumatoid arthritis(RA)
precise trigger uncertain, infection and cigarette smoking involved
what is found in 80% of RA patients
rheumatoid factor, an IgM or IgA autoantibody that binds Fc region of IgG
describe the histological changes seen in the acute phases of rheumatoid arthritis
pannus formation= inflammatory granulation tissue
hyperplastic/reactive synovium
describe the effect of rheumatoid arthritis on the cartilage of the joints
cartilage is destroyed by inflammatory process and results in loss of joint space
describe the changes seen in chronic RA
fibrosis and deformity
what % of RA patients have extra-articular manifestations
40%
give some examples of RA extra-articular manifestation
rheumatoid nodules on skin(25%), salivary gland swelling, endocarditis, anaemia
(many more)
describe the pattern of the joints that are affected by RA
symmetrical
if untreated what can RA lead to
joint damage irreversible deformities leading to loss of function and increased morbidity and mortality
what is the main structure in the joints affected by RA
the synovium
what investigations are used in rheumatoid arthritis
blood tests, inflammatory markers, imaging(eg X-ray), autoantibodies
what blood tests are done in RA
testing anaemia of chronic disease and raised platelets
what inflammatory markers are seen in RA
raised CRP, raised ESR, plasma viscocity
what factors are taken into account in the classification of RA
joint distribution, serology, symptom duration, acute phase reactants
describe the clinical features of RA
prolonged morning stiffness(>30mins), involvement small joints hands + feet, symmetric distribution, positive compression tests for MCP and MTP joints
what are some of the clinical presentations of RA
synovitis in small joints(main), poor grip strength, monoarthritis, tenosynovitis, trigger finger, carpal tunnel syndrome
what autoantibodies are seen in RA
rheumatoid factor and antibodies to cyclic citrullinated peptide(anti-CCP)
(only around 70% RA patients sensitive to these)
describe the relevance of anti-CCP antibodies in RA
can be present prior to symptoms, associated with cigarette smoking, associated with erosive damage, can be -ve and still have RA
what imaging is used in RA
always plain X-ray of hands + feet, sometimes ultrasound scanning(better in early disease), MRI scans
what score is used to calculate disease activity in RA, and what does it take into account
DAS-28
28 different joints(not feet), if they are swollen or tender, raised ESR and CRP
what is early RA defined as
defined as less than 2 years since symptom onset
give some examples of complications of untreated RA in the hands
boutonniere deformity of thumb, ulnar deviation MCP joints, swan-neck deformity of fingers
give some examples of complications of untreated RA in the feet
MCP joints have conns formed over them, may ulcerate, osteoarthritis, hallux valgus, forefoot widening, would complain walking on pebbles/marbles
are DIP(distal interpharangeal) joints involved in rheumatoid arthritis
no they are spared
