Rheumatology and RA, Told, Part I Flashcards
what are the seronegative spondylarthropathies
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
what arthritis is not inflammatory
osteo
it is degenerative
what are the cardinal signs of inflammation
pain
heat
redness
swelling
what are the additional cardinal signs of inflammation for arthritis
tenderness, stiffness, crepitation, functional impairment
monoarthritis
one joint
olig arthritis
2-4
pauci arthritis
<5 joints
poly arthritis
6+
what is the enthesis
where muscle jionts bone
what is an example of diarthrodial joint
knee
general characteristics of RA
chronic systemic non suppurative inflammatory arthropathy diarthrodial joints extra aticular
what are the acute phase reactants in inflammation
APR and CRP
fibrinogen
The greater inflammation what happens to plasma
less viscous
cells fall out of suspension
What occurs in diarthrodial joint in RA
bursitis, tendinitis, synovitis
what are initial lab signs of RA
FR +
anti CCP +
increased CRP
disease onset of RA Sx
pain, inflammation, fatigue and damage, usually 10 years brewing
types of autoAb that RF is
IgM
what type of autoimmune reaction is RA
localized immune complex from the RF produced and C’ consumed
What immune cell is responsible for damage in RA
T cells, CD8 CTL kill everything, MAC complex
what are the main pro inflammatory cytokines
TNF a
IL 1
what are the main anti inflammatory cytokines
IL4 IL10 IL11 IL13
when does RA peak age
25-45
pregnancy and RA
improves during pregnancy
mortality from RA
infection! and heart disease, malignancy
ACR classification for RA
4 of these for more than 6 weeks*
morning stiffness >1 hour* swelling in 3+ joints* swelling in hand joints* symmetric joint swelling* rheumatoid nodules rheumatoid factor erosions or osteopenia on hands x rays
RA attacks what joints commonly
MCPs PIPs, knee, ankle, subtalar, MTPs
OA attacks what joints commonly
medial knee, DIP
loss of what cells in synovium from RA knee
loss of goblet cells
ulnar deviation
RA
joint space narrowing and erosions in fingers
RA
what imaging is most useful with Dx of RA
US!! MRI, plain radiographs
what imaging study shows inflammation
US
best imaging for detecting tenosynovitis
US MRI
synovitis hallmark
increased synovial volume
what is boutonniere deformity
rupture extensor retinaculum
DIP stuck in extension
PIP in flexion
MCP in extension
what is swan neck deformity
rupture of extensor digitorum profundus
MCP and PIP extended
DIP flexed
extra articular manifestations of RA
rheumatoid nodules sjogrens syndrome feltys syndrome vasculitis rheumatoid lung cardiac disease neuromyopathy lab tests inflammatory eye Dx osteoporosis lymphadenopathy hyperviscosity cryoglobulinemia dermatologic amyloidosis
what sign of RA is always indicative of a RF+ patient
rheumatoid nodules
what ligament can be dangerously compromised in RA
transverse ligament of atlas keeps C1 on C2
what are alarming signs of spinal cord damage in RA
diminished motor power in arms and legs severe neck pain often radiating to occiput dysesthesias of fingers and feet marble sensation in limbs and trunk jumping legs from spinal automatism disturbed bladder function
what does scleritis look like
swelling of sclera
assoc with RA
what is scleromalacia
blue spots seen in sclera
What are Sicca Sx
dry eyes
dry mouth
vaginal dryness
tracheo-bronchial dryness
primary sjogrens syndrome is assoc with what
SSA (Ro) and SS-B (La) Ab
Tx sjogrens
Tx symptoms
shirmers test
eye strips to lower eyelid to see if lacrimal fluid comes out
lab findings in RA
\+RF \+anti CCP \+ ANA elevated ESR or CRP anemia thrombocytosis hyperglobulinemia leukopenia, granulocytopenia glucose in body fluids- very low
goals of therapy in RA
control disease activity alleviate pain slow rate of joint damage maintain function maximize quality of life reduce premature mortality
non Rx Tx RA is usefule when
early and late phase RA
limitations to RX Tx for RA
cost
toxicity- corticosteroids, NSAIDs, DMARDs, biologic agents
biologic agents risk factor
opportunistic infections
