Rheumatoid Arthritis & Lupus Flashcards
What is the most common inflammatory arthritis?
RA (1-2% of the population)
Is RA positive or negative for RF?
Positive
RA specifically impacts what part of the joint?
Synovial tissue
What is the term for the hyperplastic synovitis seen with RA?
Pannus
What is the gender bias associated with RA?
Females more likely (3:1)
What is the age range for RA?
20-60
At what point are men just as likely to develop RA as females?
After age 60
Is enthesopathy more frequent with RA or DJD?
DJD
What are the lab findings associated with RA?
1 RF
2 Elevated ESR
3 +ANA
4 C-RP
What is the characteristic distribution of RA?
Bilateral symmetry (and PROGRESSIVE)
What is the mechanism in which RA destroys synovial tissue?
Pannus (hardened tissue that grinds away synovial tissue)
What is the term for the enlargement of the gastrocnemius bursa which is commonly seen with RA?
Baker’s cyst
What is Boutonniere’s deformity?
PIP flexion, DIP extension
What is swan neck deformity?
PIP extension, DIP flexion
What is the term for the soft tissue nodes seen at the MCP commonly with RA?
Haygarth’s nodes
What is the number one location in the body for RA to target?
Hands (second would be wrist)
What is the term for the area between the end of the cartilage and the end of the synovium/joint capsule?
Bare area
What is the jelling phenomenon?
Stiff joints following inactivity
What is the term for the accumulation of inflammatory cells with necrotic area and fibrosis seen on extensor surfaces with RA?
Rheumatoid nodules
What is the intermittent absence of the articular codex due to erosion with RA called?
Dot-dash appearance
What is it called when RA gets so bad that it leads to the most severe case of joint deformity and destruction?
Arthritis mutilans
What is the condition that includes leukopenia, splenomegaly, and RA?
Felty’s syndrome
What is different about the loss of joint space with RA compared to DJD?
RA = UNIFORM DJD = NONUNIFORM
RA symptoms are most prevalent during what time of the day due to the jelling phenomenon?
Morning (due to inactivity)
What is the most common location in the hand for the effects of RA to take place?
MCPs (and PIPs) then proceed proximally
What is RF?
Rheumatoid factor: measurement of the reactive IgM antibodies seen in the synovial membrane
What time table is used to assess the diagnosis of RA?
At least 6 week with morning stiffness, pain upon joint motion, swelling of at least 1 joint, and swelling in at least another joint
What aspect of the wrist does RA tend to target?
Ulnar styloid area
What are all the common locations for RA?
Hands, wrist, knees, foot, cervical spine
What is the term for the marginal erosions seen with RA?
Rat bites
What is the term for the demineralization of bone near the joint that is commonly seen with RA?
Junta-Articular osteoporosis
How can RA affect the knees?
Symmetric loss of joint space of all compartments (also Baker’s cysts)
How can RA affect the hips?
Concentric (uniform) loss of joint space and acetabular protrusion
How can RA affect the shoulder?
Resorption of the clavicle
What is the biggest concern when RA reaches the cervical spine?
Increased ADI leading to atlantoaxial instability and odontoid erosions
What is the most common cause of increased ADI?
RA
Why is pannus in the odontoid region an issue?
Possibly narrowing of the canal and therefore compressive the cord
What are the normal ADI levels for children and adults?
Adults = less than 3mm Children = less than 5mm
What procedure should be done in patients with RA to assess for increased ADI?
Flexion/extension views
Patients with RA that affects the Occ-C1 and C1-C2 facet area with erosions are now at risk for what condition?
Basilar invagination
What form of Juvenile Chronic Arthritis (JRA) is more common?
Seronegative
What is another name for JRA?
Still’s disease
Does JRA more commonly involve one or multiple joints?
Multiple
How can JRA affect growth?
Either stimulate or stunt it
How does JRA affect the knee?
Ballooning of metaphysis
What is the radiographic sign seen due to the periosteal reaction of JRA at the phalanges?
“Cloaking layer”
Is fusion more common in RA or JRA?
JRA
Which level of the cervical spine usually appears fused on X-ray due to the angle?
C2/C3
What visible difference on X-ray will be seen in individuals with “old” JRA on a lateral cervical?
Hypodeveloped vertebral bodies
What category does lupus fall in?
Seropositive rheumatoid type
What are the lab findings for lupus?
1 elevated ESR
2 +ANA
3 RF positive
What dermatological feature is associated with lupus?
Butterfly rash
What is the normal population associated with lupus?
Females aged 20-40
How common is an articular complaint with lupus patients?
80-90% (but severe radiographic changes are not seen)
What is the most frequent and serious feature of SLE?
Kidney failure and nephropathy
What other organs besides the kidneys can be damaged due to SLE?
Heart or lungs (80%) and nervous system (neuropsychiatric)
What is unique about the joint involvement with lupus patients?
Normal, nonerosive joint spaces and deformities that are easily reversed
What external stimulus can irritate symptoms of both RA and lupus?
Sun
Where is the most common involvement of joint issues with those with lupus?
Hands
What other osseous issue can arise in lupus patients, especially following corticosteroid treatment?
AVN
Which joints are usually affected by lupus?
MCP and PIP (just like RA)
What kinds of deformities and positions are seen with lupus joint involvement?
Ulnar deviation, Boutonnière deformity, Swan-neck deformity
