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18 Cards in this Set
- Front
- Back
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What are the main, important questions to ask yourself when a patient presents with joint symptoms?
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- Is it actually the joint
- Acute of chronic - Inflammatory or not - What is the pattern - What is the impact on the patient |
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What are the main differences between inflammatory and non-inflammatory arthritis?
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INFLAMMATORY
- symptoms ease with excercise - morning stiffness lasts longer than 30 mins - can get systemic upset - FBC shows raised inflammatory markers - symmetrical NON-INFLAMMATORY - pain worse with exercise - morning stiffness less than 30 mins - no systemic upset - FBC normal |
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What is rheumatoid arthritis?
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A chronic, systemic inflammatory disease affecting the synovial small and large joints in a symmetrical fashion
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What is the typical presentation of someone with RA?
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- Pain and stiffness in joints
- 1 hour morning stiffness - Undue fatigue - Joint swelling - Difficulties with certain activities (putting rings on and opening jars) |
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What specific features would you ask about in an RA history?
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- Eye problems (grittiness, red eye, blurred vision)
- Skin problems (SLE, photosensetive rash) - Dry mouth - Alopecia - Raynaud's - Preceding viral illness |
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What features in the hand and wrist may you fin don examination?
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- Articular tenderness (PIP and MCP)
- Soft tissue swelling of joints - Diminished grip strength - Impaired fist formation - Features of compressive neuropathy - Stiff and restricted movement |
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What sort of lab test would you do for a patient with suspected RA?
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- FBC (anaemia)
- Urea, electrolytes and serum urate - Thyroid function tests - Liver function tests - Rheumatoid factor & autoantibodies |
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What is rheumatoid factor?
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- An autoantibody
- Directed against the Fc region of IgG antibody - Positive in 70% of RA patients - Also positive in 2-4% of healthy population - Common in other autoimmune disorders, TB and syphilis |
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What is anti-CCP?
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Anti-citrullinated peptide
90-95% of those with RA test positive Sensitivity of 50-70% May be present years before onset |
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What is anti nuclear antibody?
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ANA has a stronger connection with systemic lupus erythematosus (SLE) but also seen in RA
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Why would you take a chest X-ray for a suspected RA patient?
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- Certain pulmonary diseases also cause joint pain (lung cancer)
- Check for sarcoidosis, pleurisy, nodules and fibrosis - RA can effect the lungs |
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What radiographic features are present on hand and feet X-rays of RA patients?
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- Soft tissue swelling
- Juxta articular osteopenia (low density) - Erosions - Development of pannus |
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What does uncontrolled RA result in?
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- Joint damage and deformity
- Disability (impact on work) - Mortality (impact on CV system) |
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What happens to people with RA?
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- Functional loss
- Early retirement - Major home adaptations/ appliances |
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What are the extra articular manifestations of RA?
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- Palmar erythema
- Ulcers - Vasculitis - Dry eyes and mouth (lymphocyte infiltration into glands) |
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How does RA cause anaemia?
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- Anaemia of chronic disease
- Iron deficience anemia - Autoimmune haemolytic anemia |
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What are the 4 main aims of the MDT for treating RA?
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- Control symptoms
- Minimise impact - Minimise joint damage - Maximise function |
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What are DMARD's?
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Disease modifying anti-rheumatic drugs
- Improve symptoms - Slows progression of RA - Take weeks-months to act |
