Rheumatoid Arthritis Flashcards
associated alleles with ra
- hla drb1
- ptpn22
- padi4
pathophysio of ra
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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
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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
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