Rheumatoid Disease Flashcards
What are contraindications to joint aspiration?
PROSTHESIS (Absolute)
Ulcer (relative)
Bleeding disorder (relative)
What joints are affected in RA?
Symmetrical PIP MCP Wrists Feet
Where do rheum nodules develop
heart Pericardium lungs blood vessel skin and subcut eyes salivery and lacrimal glands
What HLA is pos in RA?
DR4
What autoABs are pos in RA?
RF and anti CCP
What points in history indicate RA?
Early morning stiffness
Physical joint swelling
Inactivity worsened stiffness
Discrete start point
What is present in synovial infiltrate?
Lymphocyes, plasma cells, macrophages and polymorphs
What is the first radiological sign?
Osteoporosis in adjecent bones (esp fingers)
What is the disease process in joints?
articular cartilege is eroded and fragmented and debris causes further inflammation, there is damage to the joint capsule and periarticular structures causing deformity.
What are signs of RA in hands?
Ulnar deviation
Carpal tunnel syndrome
Swan neck deformity and boutonnieres
Z thumb
What are extra articular features of RA?
Myalgia, weight loss, fatigue Anaemia Lymphadenopathy/splenomegaly Sjogrens Uveitis and schleritis Vasculitis Pulmonary nodules and fibrosis Amyloidosis
What investigations done in RA?
ESR CRP autoABs FBC LFT Uand E
What are radiological signs of RA?
soft tissue swelling periarticular osteoporosis Joint space narrowing erosion takes 6-12 months to change
How is RA managed?
Aim for DMARD monotherapy Methotrexate weekly or Sulfasalazine
Corticoids for flare ups (ie intraarticular methylpred)
Also flu vaccine
How does paediatric RA present?
Systemic manifestations more prominent
Pyrexia, rashes, lymphadenopathy, splenopemegaly before arthritis onset.
