Rheumatoid Arthritis

Question 1

Define rheumatoid arthritis?

Answer 1

chronic inflammatory systemic disease characterised by symetrical deforming peripheral polyarthritis and extra- articular manifestations

Question 2

what is rheumatoid factor?

Answer 2

IgM antibody which recognises the Fc portion of IgG as their antigen

IgM anti-IgG antibody

Question 3

outline the aetiology of rheuamtoid arthritis?

Answer 3

AUTOIMMUNE disease ( unknown cause )

associated with other autoimmune disease ( sjogren’s syndrome)

HLA associations- HLA- DR1, HLA- DR4

Rheumatoid factor- IgM anti IgG antibody

Question 4

what are the hLA associations of rheumatoid arthritis?

Answer 4

HLA- DR1, HLA-DR4

Question 5

describe the epidemiology of rheumatoid arthritis?

Answer 5

COMMON

1% of general population

3 x more common in FEMALES

Peak incidence: 30-50 yrs

Question 6

what are the systemic symptoms of rheumatoid arthritis?

Answer 6

fever

fatigue

weight loss

pleurisy

pericarditis

Question 7

what are the presenting symptoms of rheumatoid arthritis?

Answer 7

symmetrical, swollen, painful and stiff small joints of hands and feet, worse in the morning

GRADUAL onset

Joint pain – polyarthric involvement including large and small joints - hand wrists and elbows

Swelling

Morning stiffness lasting >1 hour – improves with motility

Impaired function

Usually affects peripheral joints symmetrically

systemic symptoms= FFWPP

Question 8

what are the extra- articular signs of rheumatoid arthritis?

Answer 8

-firm subcutaneous nodules (usually found on the elbows, ulnar margin, palms and over extensor tendons)

Can also lead to lymphadenopathy, vasculitis, fibrosing alveolitis, obliterative bronchiolitis, pleural and pericardial effusion, Raynaud’s, carpal tunnel syndrome, peripheral neuropathy, splenomegaly

Question 9

what are the early signs of rheumatoid arthritis?

Answer 9

splindling of fingers

swelling of MCP and PIP or MTP- usually symetrical

warm tender joints

reduction in range of movement

Question 10

what are the late signs of rheumatoid arthritis?

Answer 10

Symmetrical deforming arthropathy

Ulnar deviation of fingers

Radial deviation of the wrist

Swan neck deformity (DIP hyperflexion and PIP hyperextension)

Boutonniere deformity (PIP flexion and DIP hyperextension)

Z deformity of the thumb

Trigger finger (inability to straighten the finger, tendon nodule palpable)

Tendon rupture

Wasting of small muscles of the hand

Palmar erythema

Question 11

what is a swan neck deformity

Answer 11

DIP hyperflexion and PIP hyperextension

Question 12

what is a boutonniere deformity?

Answer 12

PIP flexion and DIP hyperextension

Question 13

how is the diagnosis for rheumatoid arthritis made?

Answer 13

American Rheumatism Association criteria, requiring four of the following seven factors to be present:

1. Morning stiffness >1 hour for more than 6 weeks
2. Arthritis of hand joints (wrist, MCP, PIP) for more than 6 weeks
3. Arthritis of three or more joint areas for more than 6 weeks
4. Symmetric arthritis for more than 6 weeks
5. Rheumatoid nodules
6. Characteristic X-ray findings
7. Positive rheumatoid factor The four characteristic X-ray findings of rheumatoid arthritis are soft tissue swelling, narrowed joint space, juxta-articular erosions and subluxation.

Question 14

what are the investiations for rheumatoid arthritis?

Answer 14

FBC- Low Hb ( ACD), high platelets ( inflammtion)
High ESR and CRP-> CRP more acute and ESR more chronic

Rheumatoid factor (found in 70% of RhA patients)

Anti-CCPantibodies- found in 70 of RhA patients

Joint X ray

Ultrasound and MRI- detect synovitis and bone erosions

Question 15

what does the joint x ray show in rheumatoid arthritis?

Answer 15

BONDS

Bone erosions

Osteopenia- low bone density

narrowing of joint space

deformity

soft tissue swelling