Term
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Definition
-chronic, autoimmune, inflammatory systemic disease
-unknown etiology, but many identifying factors
-causes persistent joint inflammation, destruction, deformity
-damage to bone occurs because of inflammatory cytokines such as IL-1, IL-6, and TNFa
-autoantibodies such as RF, anti CCP may indicate more severe disease
-T cells ultimately become activated and contribute to destruction of bone |
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Term
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Definition
-most common autoimmune disease, approx. 1% of pop.
-females to males 3:1
-worst prognosis in women, less educated, and lower SES
-high incidence in certain Native American tribes, rare in AA
-HLA DR4 is a risk factor, + antigen may indicate more severe disease
-smoking increases risk
-viral and bacterial antigens may play role in trigger |
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Term
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Definition
-hallmark of joint involvement; multi-layer synovial hypertrophy assoc. with destruction of bone and cartilage
-proliferative synovium filled with mononuclear cells particularly monocytes and lymphocytes
-pannus invades at bone-cartilage synovium interface which shows "marginal erosions" on Xray |
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Term
Clinical Presentation of RA
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Definition
-polyarthritis, involves small and large joints, symmetrical
-involved joints are warm, tender, swollen, may have effusion
-can involve inflammation of tendons and lead to deformities
-characteristic morning stiffness
-structural changes occur such as ulnar deviation, Swan neck deformity, boutonniere deformity, Carpel tunnel
-sx such as weight loss, fever, myalgia, anemia |
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Term
Commonly Affected Joints in RA
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Definition
-predilection for carpal joints, MCP, PIP, MTP's
-also can effect shoulder, elbow, knees, ankles
-symmetric
-spares spine |
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Term
| Extra-articular Manifestations |
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Definition
-lung disease such as nodules, effusions
-vasculitis, pericarditis, ILD, pleuritis, scleritis, anemia, thrombocytosis
-vasculitis especially of the skin, peripheral nerves, and bowel |
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Term
| Diagnostic Criteria for RA (X-ray) |
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Definition
-early findings are soft tissue swelling, articular osteoporosis or osteopenia
-loss of mineralization around joints
-"marginal bony erosions"
-may see rheumatoid nodules in lungs and other organs as well |
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Term
| Diagnostic Criteria for RA |
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Definition
-need 4 out of 7 of criteria to make diagnosis
1. arthritis in 3 or more joint areas > 6 weeks
2. swelling of wrist, MCP, or PIP joints > 6 weeks
3. Morning stiffness >1 hour
4. Symmetric arthritis > 6 weeks
5. Rheumatoid nodules (indicates systemic involvement)
6. Rheumatoid factor (&/or CCP -ab)
7. radiographic changes |
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Term
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Definition
-control pain, preserve function, prevent further progression
-aspirin and NSAIDS to control pain/inflammation, DON'T halt disease process
-corticosteroids for acute exacerbations
-DMARD's (Disease modifying anti-rheumatic drugs); Methotrexate is the most common one
-pts. can BENEFIT from exercise (water-based) |
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Term
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Definition
-70% of joint erosions detectable by x-ray of hands and feet within first 2 years of disease
-increased incidence of infections, lymphomas, leukemias, CV disease
-w/ poor management, in 20 years, over 60% of pts. will belong to functional class III which is significantly impaired, self-caring, using aids, joint replacements
-or class IV, loss of independence, requiring daily care |
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Term
| Diagnosis of JIA or "JRA" |
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Definition
<16 years old
-arthritis of 1 or more joints for 6 weeks or more
-exclusion of other causes of arthritis
-need to R/O infections, other MSK disorders, malignancies or other immune disorders |
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Term
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Definition
-most common childhood rheumatic disorder
-approx. 80,000 children in US
-onset is biphasic
-first peak: 1-3 years
-second peak: 9 years |
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Term
| Still's Disease (Systemic Onset JIA) |
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Definition
-10-20% of total, 60% males
-onset can occur at any age
-early presentation = myalgias, arthralgias
-extra-articular = fever, rash, serositis, pericarditis, lymphadenopathy, leukocytosis, anemia, thrombocytosis
-No ANA, RF
-Prognosis: 25% have severe arthritis |
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Term
| Polyarticular Onset (JIA) |
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Definition
-30% of cases
-Dx: arthritis >6 weeks, >4 joints
2 types: RF(-) and RF(+)
RF (-): more common, F>M; mild symmetric polyarthritis, no rash/fever, +ANA in 25%
RF(+): <10%, F>M; usually occurs in adolescence; severe, symmetric, polyarthritis; rheum. nodules, vasculitis, Sjogren's syndrome, 50% w/ severe deforming arthritis |
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Term
| Pauciarticular Onset (JIA) |
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Definition
-most common type of JIA, similar to polyarticular, but w/ fewer joints, single joint presentation common
-F>M
-mean age of onset = 4 y/o
-iridocyclitis in 20% (need to screen for this b/c can cause blindness)
-at greater risk if ANA + |
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Term
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Definition
-subtype of Pauciarticular onset
-90% boys, onset adolescence, arthritis >6 weeks, <5 joints
-painful, inflammatory
-extra-articular manifestations are rare
-need to exclude infection, mechanical disorder
-affects lower extremities, enthesitis, late involvement with back
-Prognosis: spondyloarthropathy, psoriasis, IBD |
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Term
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Definition
-localized growth disturbances; deformities and infantile proportions
-significant delays in gross and fine motor skills
-chronic eye disease
-psychosocial: increased rates of academic, emotional, and social difficulties, depression |
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Term
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Definition
-remission @ puberty: 40%
-may have active disease later
-5-40% need assistance w/ personal care
-need assistance w/ career development, understanding ADA rights, independent living skills
-ensure successful transition to adult health care system, work, independence, inclusion in community
-START EARLY!!! |
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