Rheumatoid Arthritis Flashcards
associated alleles with ra
- hla drb1
- ptpn22
- padi4
pathophysio of ra
read
pathological hallmarks of ra
- synovial inflammation and proliferation
- focal bone erosions
- thinning or articular cartilage
what is a pannus
mass of edematous synovium, inflammatory cells, granulation tissue, and fibroblasts
classic clinical picture
chronic inflammatory symmetric polyarthritis
inflammatory features
- tender, warm, swollen
- morning stiffness
- symmetric
joints involved
- small joints of hands and feet
- wrists, metacarpal phalangeal joints, pip
- flexor tendon tenosynovitis
- dips spared
ra specific deformities
- ulnar deviation
- boutonniere deformity
- swan neck deformity
- zigzag deformity
- “piano key movement” of ulnar styloid
natural history
- early: metatarsophalangeal joint pain
- ankle and mid-tarsal region
- atlantoaxial of cervical spine
- late: large joints (knees and shoulders)
most common extra articular symptoms
- weight loss
- fever
- fatigue
- malaise
- depression
risk factors for systemic inolvement
- cigarette smoking
- early onset of significant physical disability
- (+) rf or anti-ccp antibodies
common hematologic manifestation
- anemia of chronic disease
- felt’s syndrome: neutropenia, splenomegaly, nodular rheumatoid arthritis
renal and cardiac manifestation
- membranous nephropathy
- secondary amyloidosis
- ischemic heart disease
differentials for ra
- infectious/ viral arthritis (chikungunya, dengue, hep b)
- sle
- psoriatic arthritis
- other ct/ autoimmune diseases
t/f sle results in erosions and irreversible deformities
false
ra vs osteoarthritis
read
clinical findings in oa
- short morning stiffness, worsened by effort
- bouchard’s nodes
- heberden’s nodes
- (-) rf and anti-ccp
serology
- rf: negative in first year
- acpa
- elevated esr and crp
synovial fluid analysis
- 5,000-50,000 wbc/ul with neutrophilic predominance
- decreased string sign
- most useful for confirming inflammatory arthritis or execluding infection
plain xray findings
- periarticular osteopenia or no changes
- soft tissue swelling, symmetric joint space loss, subchondral erosions
mri findings
- early detection
- greatest sensitivity for synovitis and joint effusions
uts and doppler
- detect more erosions
- detect synovitis and increased vascularity (= inflammation)
2010 acr/eular classification for ra
joint: 1 large, 2-10 large, 1-3 small, 4-10 small, >10
serology
acute phase reactants (crp and esr)
duration (6 wks)
6 = definite ra
approach to treatment
read
remission
- tender joint count less/= 1
- swollen joint count less/= 1
- crp less/= 1
- patient global assessment less/= 1
OR simplified DAI less/= 3.33
factors for improved outcome
- methrotrexate = toc for early ra
- combination dmard > methotrexate
pharmacologic treatment
- nsaids
- glucocorticoids
- dmards
- biological dmards
glucocorticoids
- low to moderate doses before dmard therapy
- high dose for severe
risks to chronic glucocorticoids
- osteoporosis
- infection
- cushing’s
- gastritis
dmards
- methotrexate
- leflunomide
- hydroxychloroquine
- sulfasalaizine
- others
biological dmards
- tnf: infliximab, adalimumab, goli, certolizu, etanercept
- cd28/cd80/cd86: abatacept
- ccd20: rituximab
- il6: tocilizumab, sarilumab
- jak: tofacitinib, barcitinib
contraindications for tnf targeting
- chronic infection (hep b/c)
- class 3/4 heart failure
___ have spontaneous remission within 6 mos
10%
clinical course
- majority have persistent and progressive disease
- 2x higher mortality (ischemic heart disease, infection)
risk factors for shortened lifie expectance
- systemic extraarticular involvement
- low functional capacity
- low socioeconomic status
- low education
- chronic prednisone use
