Week 8 - Rheumatoid

Question 1

Pathophysiology

Answer 1

• chronic, systemic, autoimmune inflammatory disorder of unknown aetiology that primary involves synovial fluid
• typically symmetrical and if uncontrolled usually leads to destruction of joints due to erosion of cartilage and bone causing joint deformities
• progresses from the periphery to more proximal joints and results in significant locomotor disability within 10 to 20 years in patients whose disease does not respond to treatment

Question 2

Presentation

Answer 2

Polyarticular disease and with a gradual onset, some present with acute onset, with intermittent or migratory joint involvement with monoarticular disease

Question 3

Symptomology

Answer 3

• affect pts capacity to perform the activities of daily living and those required in their occupation
• systemic symptoms may also present in patients, particular those with disease onset after age 60
  Typical: - usually insidious - pain, stiffness (morning stiffness) and swelling of joints
• MTP joints of the toes

Question 4

Morning stiffness

Answer 4

Common features of those with active RA
- if lasts more than 1 hour - reflects severity of joint inflammation that rarely occurs outside active inflammatory arthritis

Question 5

Extra articular involvement

Answer 5

Aching, stiffness, symptoms of bilateral carpal tunnel syndrome, loss of weight, depression - may antedate the onset of polyathritis by many months
- involvement of msk system other then joints (bone and muscle) and of extra articular organs (skin, eyes, lungs, heart and others) occurs in approx 40% of patients with RA over the course of the disease

Question 6

Physical finding of joint inflammation

Answer 6

Pain and swelling
- painful inflammation = local tenderness from pressure applied on the joint or by pain on moving the joint
- swelling may be due to synovial hypertrophy or effusion

Question 7

Radiographic changes

Answer 7

• joint space narrowing and bony erosions- typically evaluated using plain radiographs of the hands and feet
• become evident overtime
• erosions of cartilage and bone are among the cardinal features of RA
• can occur is some other forms of inflammatory and gouty arthropathy and are therefore not diagnostic of RA in and of themselves
• 5th MPJ is frequently the first joint affected
• finding at the 1st MPJ are generally subtle or unremarkable
• early recognition is difficulty with radiography - CT may be necessary

Question 8

Grading

Answer 8

1 - no radiogrpahic changes
2 - slight abnormality
2 - definite early abnormality
3 - medium destructive abnormality
4 - sever destructive abnormality
5 - mutilating abnormality

Question 9

Radiogrpahic features

Answer 9

• erosion
• even joint space narrowing
• peri articular osteopenia
• loss of joint apposition
• tubular deviation of toes 1-4 at MPJ level
• erosion of calcaneal bursa, projection associated with retrocalcaneal bursitis
• progressive ankylosis

Question 10

Digital misalignment and joint subluxation/dislocation

Answer 10

• all toes (except the 5th) generally divide in a fibular direction relative to the metatarsal however, this finding is not specific to RA

Question 11

Ankylosis

Answer 11

• in the late stages of RA, the joint space may disappear entirely and the 2 bones appear united as 1
• appears more frequently in the tarsus but can also affect the 1st ray
• less frequent