Rheumatoid Arthritis Musculoskeletal Blueprint (smartypance.com)
Terms in this set (21)
What is RA?
An inflammatory, multisystem disease with flares and remissions, characteristic chronic deformities, and systemic features
What is the incidence of RA?
RA occurs in 1%-2% of all adults. It is the most common autoimmune disease.
What risk factors are associated with RA?
Female gender and family history
What are the symptoms and signs of RA?
Morning stiffness for >1 hour; symmetrical joint pains; inflammation in hands (typically in the MCP and PIP joints with sparing of the DIPs), wrists, feet, knees, hips, shoulders, and elbows; fatigue; weight loss; fever; and subcutaneous nodules
What does the examination of the rheumatoid hand find?
Early: Synovitis (inflammation of the synovium) Late: Ulnar drift caused by tendon laxity; subluxation of proximal phalanges under MCP heads; swan neck and boutonniere deformities; and nodules on bony prominences and extensor surfaces
How common is RF in patients with RA?
RF is present in 80% of cases.
What is RF?
An autoantibody (usually IgM) directed against the Fc fragment of IgG
What other conditions are associated with RF?
Subacute bacterial endocarditis, viral infections (e.g., infectious mononucleosis, hepatitis C, tuberculosis, Lyme disease), increasing age, and sarcoidosis
What is anti-CCP?
An antibody directed against cyclic citrullinated peptide is found in 60% of patients with RA. Anti-CCP is more specific than RF.
What are the radiographic findings in RA?
Periarticular swelling Juxta-articular osteopenia, then generalized osteoporosis Uniform joint space loss Marginal erosions Subluxations
How is the diagnosis of RA made?
Documentation of inflammatory synovitis by the following:
1. Synovial fluid WBC count > 2,000/mm3
2. Chronic synovitis on histologic study
3. Radiologic evidence of erosions
4. Symptoms must be present > 6 weeks.
What agents can be used to provide symptomatic relief in RA?
NSAIDs, analgesics, and corticosteroids
What are the benefits of these agents? What are the drawbacks of these agents?
These drugs are rapidly acting but they appear to have minimal impact in terms of slowing progression of the underlying disease process.
When are DMARDs started?
DMARDs should be initiated early in the course of the disease as joint damage can occur rapidly within the first several years of disease onset.
What are the second-line medication therapies?
Include hydroxychloroquine, methotrexate, gold, azathioprine, sulfasalazine, leflunomide, etanercept, infliximab, adalimumab, rituximab, abatacept, golimumab, certolizumab pegol, and anakinra
What are the other important therapies?
May include physical and occupational therapy, local joint injections with steroids, and surgery for joint stabilization or replacement
When are oral steroids used?
Oral steroids should be used for "bridge" treatment (i.e., while waiting for DMARDs to control symptoms).
When is the treatment of RA urgent?
For severe flares, vasculitis, or joint/systemic infections
When is the treatment of RA emergent?
When there is severe adrenal insufficiency (Addisonian crisis) and atlantoaxial (C1-C2) instability
What is adult-onset Still disease?
Similar to systemic-onset JRA, but in adults
What are the symptoms and signs of adult-onset Still disease?
Sudden onset of high, spiking fever, sore throat, and evanescent erythematous salmon-colored rash. Arthritis involves PIPs, MCPs, wrists, knees, hips, and shoulders.