rheumatology Flashcards
oligo
2-4
pauci
<5
extended pauci
5 or 6
poly
> 6
enthesis
where mm attach to bone
arthropathy
joint deformed
diarthrodial joints
joints with synovium
what is primarily inflamed in RA
synovium -> synovitis
where are rheumatoid factors produces
in affected joints synovium
what do the rheumatoid factors do?
fix C’ -> C’ consumed -> C’ fragments recruit and activate PMNs -> Ab prodction
what type of hypersensitivity rxn is RA
immune complex type III hypersensitivity
phases of RA
initial immune stirrings
pre-symptomatic phase
disease onset
overall 10 year progression
initial immune stirrings
RF+
anti-CCP +
increased CRP
pre-symptomatic phase
can start to see neutrophil infiltrate in joints
disease onset
pain, inflammation, fatigue, damage
what are the 2 cytokines most implicated in RA
TNF-alpha
IL-1
peak age of onset of RA
25-45
what are some other diseases that people with RA are at risk for
infection renal disease GI disease heart disease malignancy (highest increased risk)
what condition has highest associated mortality in RA pts
heart disease
RA dx
must have 4 of the following for at least 6wks:
- morning stiffness >1hr
- swelling in 3+ joints
- symmetric joint swelling
- rheumatoid nodules (pathognomonic)
- rheumatoid factor
- erosions or osteopenia on hand x-ray
what is the best modality for RA imaging?
US!!
MRI good too, just a lot more expensive
common hand deformities of RA
boutonnieres
swan-neck
ulna deviation
extra-articular manifestations of RA
rheumatoid noduels sjogrens felty syndrome vasculitis rheumatoid lung cardiac disease neuromyopathy laboratory inflammatory eye dis osteoporosis lymphadenopathy hyperviscosity cryoglobulinemia dermatologic amyloidosis
alarming signs of spinal cord damage in RA
diminished motor power in arms and legs severe neck pain often radiating to occiput dyesthesias of fingers and feet marle sensation in limbs and trunk jumping legs, d/t spinal automatism disturbed bladder fnx
