Rheumatoid Arthritis (RA) Therapeutics

Question 1

What is the difference between a healthy joint, OA and RA regarding joint structure.

Answer 1

Normal Joint: Bone, Synovial Membrane + Cartilage = Normal
OA Joint: Bone ends rub together, thinned cartilage.
RA Joint: Bone erosion, inflamed & swollen synovial membrane.

Question 2

What is RA?

Answer 2

Rheumatoid Arthritis - A systemic autoimmune inflammation disorder. (Joint inflammation)

Question 3

What is the general pathology of RA?

Answer 3

Inflammation of the synovial joints causing pain, swelling, stiffness, erosion leading to joint destruction.

Question 4

At what age can symptoms of RA occur?

Answer 4

> 25 yrs

Question 5

Which gender is most likely to get RA?

Answer 5

Females (2.7:1 ratio)

Question 6

What is the difference between RA and OA regarding presentations and symptoms?

Answer 6

RA:
* Swollen Inflamed Synovial Membrane
* Bone Erosion
* Autoimmune Disease
* Symmetrical (if one joint is affected, the other joint is affected too)
* Pain, Stiffness, Inflammation
* Morning stiffness = > 30 mins

OA:
* Loss of articular cartilage
* Bone ends rub together
*Degenerative disease
* Pain & Stiffness in movement
* Morning Stiffness = < 30 mins.

Question 7

What are the symptoms of RA?

Answer 7

• Pain
• Inflammation
• Morning stiffness > 30 mins
• Swelling

Question 8

Explain how swelling occurs in RA.

Answer 8

Synovial tissue in the caps of joints becomes damaged causing the tissue to thicken and swell.

Question 9

Explain how stiffness occurs in RA.

Answer 9

Inflamed joints tend to stiffen and are difficult to move correctly. People who have RA experience stiff joints, especially in the mornings or after long periods of rest. This can last for hours at a time.

Question 10

Explain how pain occurs in RA.

Answer 10

Cartilage and bone within the joints will wear down over time. Joints are supported by surrounding muscles, ligaments and tendons, but, with RA, these will weaken and no longer stabilize joints. This causes intense pain and joint damage.

Question 11

Explain how redness occurs in RA.

Answer 11

Joints can be warm and may appear pink (or even red) on the outside during a flare or when inflamed.

Question 12

Label the anatomy of the hand.

Answer 12

Refer to Slide 7

Question 13

What are the signs indicating early stage RA?

Answer 13

1. Fixed Flexion / Fixed Hyperextension of PIP = impairs hand function.
2. Swelling & Dorsal Subluxation of the Ulnar Styloid: Causes wrist pain can lead to finger extensor tendon rupture which can further progress to a sudden drop of the little and ring fingers that may need urgent surgical repair.

Question 14

What is fixed flexion/hyperextension?

Answer 14

When the joints in the hands are fixed in a particular position in which case the hands will have a swan-like deformity impairing hand function.

Question 15

What can cause wrist pain?

Answer 15

Swelling & Dorsal Subluxation of the Ulnar Styloid

Question 16

13. What can the wrist pain eventually progress to?

Answer 16

Causes wrist pain can lead to finger extensor tendon rupture which can further progress to a sudden drop of the little and ring fingers that may need urgent surgical repair.