RA patho

Question 1

RA definition

Answer 1

-chronic dx
-symmetrical joint involvement
-most common systemic inflammatory dx

Question 2

RA epidemiology

Answer 2

-1-2% of population
-onset 30-50yo
-shortens lifespan 3-18 years
-women
-maybe genetic (HLA-DR1 and DR4)

Question 3

RA patho

Answer 3

-inflammed synovial membrane
-T lymphocyte (pannus)
-macrophages (pannus)
-neutrophils (synovial fluid)

Question 4

RA joint destruction

Answer 4

-pannus invade and destroy cartilage and bone
-inflammation goes down in late stage when no cartilage left

Question 5

Clinical RA presentation

Answer 5

-fatigue
-weakness
-loss of appetite
-joint pain
-fever
-stiffness+muscle ache from swelling

Question 6

RA diagnostic criteria

Answer 6

-joint involvement
-serology
-duration of sx
-acute phase reactants
-diagnosed w RA if there is a score of 6+

Question 7

Joint involvement

Answer 7

-elbows
-shoulders
-wrists
-knees
-ankles?
-MCP and PIP joints

Question 8

RA vs osteoarthritis

Answer 8

-less in back, hips, clavicle, knees
-more in feet, elbows

Question 9

Extraarticular manifestations

Answer 9

-rheumatoid nodules
-Cardiac
-vasculitis
* Felty’s
* Other
-pulmonary
-ocular

Question 10

rheumatoid nodules

Answer 10

-hands, elbow, forearms (pressure points)
-more common in erosive dx
-20% pt affected
-asx = no intervention

Question 11

vasculitis

Answer 11

-inflammation of small, superficial blood vessels
-depends on duration of dx
-stasis ulcers
-infarcation = necrosis

Question 12

Pulmonary

Answer 12

-effusions
-fibrosis
-nodules
-rare: pneumonitis or arteritis

Question 13

Ocular

Answer 13

-keratoconjuctivitis sicca
-itchy, dry eyes + inflammation
-sjorgens syndrome
-inflammation of sclera, cornea
-nodules

Question 14

cardiac

Answer 14

-inc CV mortality
-pericarditis
-conduction abnormalities
-rare: myocarditis

Question 15

Felty’s

Answer 15

-splenomegaly
-neutropenia

Question 16

Other manifestations

Answer 16

-lymphadenopathy
-renal dx
-thrombocytosis
-anemia

Question 17

Lab indicators

Answer 17

-anemia
-RF
-thrombocytosis
-Anti-CCP/ACPA
-ANA
-Joint aspirations
-Radiographic findings
-OPP

Question 18

Erythrocyte sedimentation rate (ESR)

Answer 18

-non-specific
->20 in RA

Question 19

C-reactive protein (CRP)

Answer 19

-+>0.5
->10 can indicate bacterial infection

Question 20

Rheumatoid factor

Answer 20

-Ab for IgM
-only 60-70% are RF+

Question 21

Anti-CCP/ACPA

Answer 21

-high specificity
-present earlier in dx
-predictive of erosive dx
-marker of poor prognosis

Question 22

Antinuclear Abs (ANA)

Answer 22

-inc levels suggest autoimmune dx
-more indicative of SLE

Question 23

Joint aspiration

Answer 23

-turbid
-WBC: 5000-50000
-glucose normal to low

Question 24

Radiographic changes

Answer 24

-joint space narrowing
-erosion of bone

Question 25

Poor prognosis

Answer 25

-social factors: -low socioeconomic -stress -poor health assessment questionare scores -lack of education -physical: -extra-articular manifestations -inc ESR and CRP -inc RF and anti-CCP/ACPA -erosions on Xray -swelling

Question 26

RA vs osteoarthritis

Answer 26

-any age (vs>40) -systemic -inc ESR -inflammation -symmetric -morning stiffness >1h -osteophyre absent -pannus present -RF+ -SC nodules -symmetric swelling -malaise, fatigue, pain, fever