Rheumatoid arthritis Flashcards
When is the pain worse?
In the morning.
What is the pathophysiology of RA?
· Inflamed synovium is central to the pathogenesis.
· Synovium shows:
- Increased angiogenesis.
- Cellular hyperplasia.
- Influx of inflammatory cells.
- Cytokines.
· High levels of metalloproteinase.
What is the aetiology of RA?
· Unknown, but thought to involve a type III hypersensitivity reaction.
· Associated with HLA DR4 and HLA DR1.
What risk factors may contribute to a person developing RA?
· Genetic predisposition - FHx.
· Smoking.
What hand signs and symptoms may occur?
· Z deformity. · Boutonniere deformity. · Swan neck deformity. · Ulnar deviation. · Raynaud's.
What wrist signs and symptoms may occur?
Carpal tunnel syndrome.
What feet signs and symptoms may occur?
Subluxation of toes and hammer toe deformity.
What skin signs and symptoms may occur?
Rheumatoid nodules and vasculitis.
What cardiovascular signs and symptoms may occur?
Atherosclerosis is increased in RA.
What respiratory signs and symptoms may occur?
Pulmonary fibrosis.
What bone signs and symptoms may occur?
Osteoporosis.
What other signs and symptoms may occur?
· Pain and swelling.
· Morning stiffness.
What investigations would you request if you suspected a patient had RA?
· Bloods.
· X-ray.
What are the typical blood results for RA?
· ESR and CRP - raised.
· RF and anti-CCP antibodies - positive.
What would a typical RA x-ray show?
Bony erosion, subluxation, carpal instability, joint involvement and osteoporosis.
List some differentials.
· Psoriatic arthritis. · Infectious arthritis. · Gout. · SLE. · OA.
What are the 3 management options?
- Conservative.
- Medical.
- Surgery.
What conservative management options are available?
Patient education - exercise, physio.
What medical management options are available?
· Glucocorticoids.
· DMARDS - Disease modifying anti-rheumatic drugs - such as methotrexate.
· NSAIDs.
What surgical management options are available?
Arthroplasty or replacement.
What treatment option is available for non-pregnant patients?
Methotrexate.
What complications may occur?
· Work disability. · Increased joint replacement surgery. · Increased CAD. · Increased mortality. · Carpal tunnel syndrome.
