Rheumatology Flashcards
Rheumatoid arthritis
Autoimmune
Inflammation of synovial joints
RA vs OA morning stiffness
Ra >30min
OA <10min
Sjorgens
Inflammation of lacrimal glands
Dry mouth and eyes. Joint fatigue and pain.
Ro and La antibodies.
Primary vs secondary sjorgens
Primary occurs on own but secondary occurs with rheumatic illness e.g. RA
Hand signs of RA
Swan neck of fingers Ulnar deviation (fingers out to side) Knuckle swelling and subluxation Z thumb Boddy swelling (except Knuckle near finger nail)
Extra articular RA features
Lung - nodule, fibrosis and crackles
Cardiac - Myocarditis, valve Inflammation
Skin- nodules on back of elbow (rheumatoid nodules) and inflamed small BV
Secondary sjorgens
RA blood test
Anaemia
Abnormal platelets
Inflammatory markers (CRP, ESR)
Auto antibodies
Xray early ra signs
Osteopenia around joing
ST swelling
Late RA Xray signs
Erosins
Narrow joint space
Subluxation/dislocation
Ankylosis (fusion)
RA treatment steps
Relief then dmards then biologic
Methotrexate
DMARD Often used in combo with another DMARD Lowers Inflammation Renally excreted and has some lung comps Nausea and mouth ulcers Contraindicated preconception
Stop 2 weeks prior to surgery until 2 weeks later or would heals
Biologic drugs
IV infusion or injection weekly
Decrease inflammation by targeting specific part of immune system
Anti TNF is main (Infliximab)
Stop 2 weeks prior to surgery until 2 weeks later or would heals
Why are biologic drugs sometimes forgotten by pts?
Not on repeat prescription as given as injection or IV infusion
Rheumatoid neck
Erosion of c1/c2.
Can compress SC (drunken walk, pins and needles, hand feet sense change).
Wonky head
Dental chair positioning.
RA OH impact
Hard to hold toothbrush
Immunosuppressive drugs compound caries and gingivitis
Pt often have osteoporosis (bisphosphonates- MRONJ)
