Term
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Definition
| systemic, symmetric inflamm polyarthritis that leads to joint destruction, deformity and loss of function |
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Term
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Definition
hallmark of RA
inflammation in synovial membrane that causes destruction |
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Term
| What are the genetic factors that may be involved in RA? |
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Definition
HLA-DR4 and DR1 Class II MHC leukocyte antigen types
enhanced T-cell response
intrinsic abnormalities in synovial responsiveness |
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Term
| What is the clinical presentation of RA? |
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Definition
insidious onset
peripheral joints of hands(MCPs, PIPs, wrist) and feet (MTPs and ankles), and axial and central joints (C spine, hip, shoulder, TM) |
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Term
| What joints in the hands are spared in RA? |
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Definition
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Term
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Definition
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Term
| What are the stages of RA seen in the hand? |
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Definition
early: synovitis causes fusiform digits
intermed: subluxation at MCP joints
Late: swan neck deformities |
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Term
| What do rheumatoid nodules indicate in terms of prognosis? |
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Definition
| worse outcome/more agressive |
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Term
| What is seen systemically w/RA? |
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Definition
general: weight loss, fatigue, fever
ocular: keratoconjuctivities, episcleritis, scleritis, scleromalacia perforans
pulm: interstitial fibrosis, pulm nodules, pleuritis, pleural effusions, brochiolitis obliterans, caplan's syndrome
derm: subcut nodules, leukocytoclastic vasculitis, palmar erythema ischemic ulcers
neuro: periph neuropathy, entrapment syndromes, cervical myelopathy, mononeuritis multiplex
hematologic: anemia, lymphoma, felty's syndrome
cardiac: pericarditis, myocarditis, coronary vasculitis |
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Term
| ACR diagnostic criteria for RA |
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Definition
must be present for 6 weeks
requires 4 of the criteria: morning stiffness > 1hr, >3 joint areas involved, hand joints, symmetric, rheumatoid nodules, serum RF, radiographic changes |
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Term
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Definition
10-15yr reduction in life expectancy w/severe disease
extra-articular involvement doubles likelihood of dying |
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Term
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Definition
ESR/CRP elevated
RF, anti-CCP (+)
ANA (+)
RF: 70% are positive at disease onset, 10-15% positive w/in 2 years; RF is not specific for RA |
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Term
| What else could the presence of RF indiciate? |
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Definition
| hep B or C, HIV, chronic infections, SLE, Sjogrens, Sarcoidosis, Asbestosis |
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Term
| Explain the significance of the anti-CCP |
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Definition
very specific to RA
found in Hep C too
predicts progression of radiographic joint at 5 years better than RF |
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Term
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Definition
up to 93% of patients have joint erosions wothin 2 years of RA onset
can be detected by MRI within 4 months of RA onset
rate of progression is singificantly more rapid in the 1st year than 2nd and 3rd |
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Term
| When are corticosteroids used for RA? |
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Definition
| as a bridge to effective DMARD treatment; avoid using without DMARDs |
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Term
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Definition
most used DMARD in RA in US
onset of action within 1-2 months: improves joint pain, swelling, functional status, ESR, slows radiographig progression
AE: stomatitis, mouth soreness, nausea, loose stools, transaminitis, cirrhosis, headache, fargieu, alopecia, interstitial lung disease, macrocytosis, BM supression, lymphoprolif malignancies, nodulosis, abortifacient and teratogen |
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Term
| Explain how DMARDs are used to treat RA? |
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Definition
most effective when combined with 2 or 3 drugs
should start by 3 months of symptoms onset |
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Term
| What is important to consider before doing surgery on a patient with RA? |
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Definition
| check C-spine, because RA can cause asymptomatic instability of the neck (subluxation of C1 on C2), which can cause SCI when manipulated under anesthesia |
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Term
| What are some clues for C1-C2 subluxation? |
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Definition
long-standing RA or JRA
c2-c3 radicuar pain in neck and occiput
spinal cord compression: quadriparesis, paraparesis, sphincter dysfunction, sensory deficits, TIAs secondary to compromise of the vertebral arteries |
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Term
| What is methotrexate lung? |
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Definition
dry cough, SOB, fever
most often seen in the first 6 months of MTX treatment
diffuse interstitial pattern on xray
risk factors: old age, RA lung, prior use of DMARD, low albumin, diabetes |
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Term
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Definition
Macrophages T-cells and B-cells produce inflamatory cytokines
Cytokines induce synovial proliferation
Proliferation forms of synovial forms pannuses which invade the bone tissue and damage the joint |
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Term
| what are the xray findings w/RA |
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Definition
Periarticular Osteopenia->
Joint Space Narrowing->
Erosion(First evident on the styloid process of the Radius) |
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