Rheumatoid arthritis Flashcards
1
Q
What is RA?
A
Autoimmune seropositive inflammatory arthropathy
2
Q
Where is most commonly affected?
A
Small joints in hands and feet
3
Q
Can large joints be affected?
A
Yes as disease progresses
4
Q
Which joints are affected?
A
PIP
5
Q
Which joints are unaffected?
A
DIP - minimal synovium
6
Q
Who gets it?
A
Women more likely
Inc with age
35- 50 is peak
Genetic factors
7
Q
Causes?
A
HLA- DR4 mediated
Cause unknown
8
Q
Potential triggers?
A
Infections, stress, cigarette smoking, bereavement
9
Q
Pathogenesis?
A
Immune response initiated against synovium
Inflammatory panes forms which attacks auricular cartilage -> joint destruction
10
Q
Clinical features?
A
Pain & stiffness in small joints (PIP, MCP, MTP's), not DIPs Prolonged morning stiffness Symmetrical Positive compression tests Can't make fists Rapid onset Swelling
11
Q
S factor for inflammatory ?
A
Stiffness (morning, >30 mins)
Swelling
Squeezing is painful
12
Q
Extra- articular manifestations?
A
Rheumatoid nodules (extensor surfaces or areas of freq irritation) Lung involvement CVS mortality > OCular involvement Dry eyes, mouth Persistent synovitis in hands
13
Q
Ocular involvement?
A
Keratoconjunctivitis Sicca Episcleritis Uveitis Nodular scleritis
14
Q
Investigations?
A
Anti- CCP antibody (very specific & preferred) Rheumatoid factor CRP, ESR, plasma viscosity - raised X-rays Ultrasound MRI - gold standard
15
Q
X-ray findings?
A
Often none Early features: - Peri- articular osteopenia, soft tissue swelling Late: - Erosions, subluxations
