Rheumatoid type Arthritis Flashcards
General
Rheumatoid type arthritic disorders are autoimmune, inflammatory disorders with common denominators. These are seen more commonly in females and are associated with antigen-antibody reactions in different systems. Th antigen is altered IgG which is reacted to by IgM. The unknown with the rheumatoid types is what alters the IgG. The IgM reactive to IgG is the rheumatoid factor which is one of the common denominator positives of the rheumatoid type disorders. Because rheumatoid arthritis has a specific target of the synovial membrane, it is the most severe arthritic disorder of the group.
Rheumatoid Types
- Rheumatoid arthritis
- Systemic lupus erythematosus - SLE
- Progressive systemic sclerosis (PSS) - AKA- scleroderma
- Dermatomyositis
- Polymyositis
Rheumatoid arthritis
more common in women with an onset between 20 and 60 years. Symptoms of pain, tenderness, swelling and morning stiffness. Remember the 7 specific diagnostic criteria. Rheumatoid is characteristic in its bilateral and symmetrical involvement 80%. Classically begins distally involving the PIP, MCP and wrist articulations. Rheumatoid nodules typically found subcutaneously adjacent to the ulna at the forearm, can also be found intra-osseously and report prognostic indicator.
Rheumatoid arthritis (contd)
Permanent hand deformities include, ulnar deviation, boutonniere deformity, swan-deformity, mallet finger and the most severe is arthritis mutilans which is typically a combination of all deformities. In the foot, dorsal dislocation and fibular deviation of the digits at the MTP joints is referred to as the Lanois deformity. Bilateral hip acetabular protrusion is the arthritis mutilans deformity in the hip joints.
SLE (Systemic lupus erythematosus )
deposition of immune complexes involving multiple systems of which the joint happens to be one of them, typically involves females in the childbearing years with an incidence of - 48/100,000. Skin and joints commonly involved and kidney involvement may be severe, skin produces a “butterfly rash” in - 40%, 90% have joint symptoms of pain, swelling and stiffness
SLE (Systemic lupus erythematosus ) contd.
Key finding is passively reversible hand deformities typically of ulnar deviation and possibly boutonniere or swan-neck. May have calcinosis circumscripta. Remember the impacts of corticosteroid osteopathy which includes osteopenia, fractures and avascular necrosis
PSS(Progressive Systemic Sclerosis) aka scleroderma
typically in females between 30 and 50 years of age, inflammatory with resulting scarring typically involving skin, lungs, G.I. tract (esophagus, small bowel and large bowel), heart, kidneys and musculoskeletal system. 90% will have Raynaud’s phenomenon (look it up). Commonly associated with CREST which stands for (calcinosis, Raynaud’s, esophageal dysfunction, scleroderma, telangiectasia).
PSS(Progressive Systemic Sclerosis) aka scleroderma contd.
Calcification of soft tissue is common in scleroderma is referred to as calcinosis (cutis in the skin, circumscripta is deeper but localized in the tissue and universalis is widespread soft tissue calcification). Main pathological finding is tightening of the skin in the hands feet and face with resulting acroosteolysis (distal tuft resorption). Arthritis involvement is non-erosive but they may show selective erosive distraction of the first MCC (metacarpotrapezium) joints bilaterally
Dermatomyositis(DM) and polymyositis(PM)
disorders of unknown origin although likely autoimmune and are found most commonly in middle-aged females. Dermatomyositis may occur secondary to neoplasms of the lung, prostate, female pelvic organs, breast as well as G.I.
Dermatomyositis(DM) and polymyositis(PM) contd.
Key feature is non-suppurative inflammation of skeletal muscle with weakness and erythematous skin rash in DM. Inflammation eventually leads to scarring of fascia and subsequent fascial calcification of the calcinosis universalis type. Arthritis consists of nondestructive small joint inflammation and possible tuft resorption which resembles PSS and SLE
Mixed Connective Tissue Disease
is characterized by overlapping clinical features of PSS, SLE, DM and possibly RA. Arthropathy consists of arthralgia and arthritis common in the small joints of hand, foot and wrist
Jaccoud’s arthropathy
Is an infrequent, deforming, non-erosive hand and foot arthropathy and with chronicity results in hand deformities similar to RA and SLE. Like SLE, the hand deformities of ular deviation, boutonniere and swan-neck are passively reducible but return actively. Ulnar deviation is typically produced by RA, SLE and Jaccoud’s.
Sjogren’s syndrome
is a syndrome due to lymphocytic accumulation in the ductal systems of exocrine glands resulting in obstruction; can be primary or secondary and is most commonly seen in females in the 40 to 50 year range. Is associated with a triad of: keratoconjunctivitis sicca (dry eyes), xerostomia (dry mouth) as well as other areas of dryness including the nose, skin and vagina, rheumatoid type disorder (most commonly RA). Is considered to be the third most common rheumatic autoimmune disorder next to RA and SLE
Juvenile Chronic Arthritis (JCA)
is the classification for inflammatory arthritic disease in pediatric patients. Peds patients get inflammatory arthritis but not DJD. The arthritis that occurs in these conditions is remarkably similar.
JCA
- Juvenile onset adult type RA (Rh factor +)
- Still’s disease (Rh factor -) has three subtypes
- classic systemic form
- poly-articular form
- pauciarticular or monoarticular form (one or a few joints)
- Juvenile onset rheumatoid variant arthritic types (AS, PA and inflammatory bowel arthroitis)
