Rheumatoid Arthritis Word Scramble
|
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Question | Answer |
Joints most affected by RA | ankles, wrists, shoulders |
RA epidemiology | Worldwide: 0.8% adult; US: F 40-50/100,000; M 20-25/100,000; by age 65 M:F = 1:1; Lifelong; 3-5 yr reduction in life exp; Incidence is declining |
RA pathogenesis | Genetics: both susceptibility & dz severity; HLA-DR 1 and DR4 alleles |
RA: Poss infectious triggers: | Mycoplasma, Mycobacterium, enteric bacteria; rubella, parvovirus B19, EBV |
RA: Other poss risks: | tea, high vitamin D intake, silicate exposure |
RA pathology | trigger; prolif syn macrophages / fibroblasts; lympho invade perivascular space; affected jt vessels occluded, synovium forms pannus (which invades cart & bone); cytokines, proteinases, ILs released; jt destn |
RA Clinical manifestations: | slow, insidious onset; durations of sx = wks to mos; fatigue, malaise, low-grade fever, wt loss; 10-15% advanced, fulminant sx; joints are typically swollen (boggy) and/or warm; erythema not common |
RA: pts c/o pain & stiffness: | 2/3 pts c/o pain & stiffness in multiple joints, 1/3 c/o pain and stiffness in one or a few joints |
RA classic presentation: | small bones of hands/feet most likely to be affected early (PIPs, MCPs, MTPs) |
RA: progression to larger joints: | wrists, knees, elbows, ankles, hips, shoulders |
RA: around inflamed joints: | may be atrophy of muscle around inflamed joints |
RA typical course: | waxing/waning over years with acute episodes involving single or multiple joints |
RA: Articular manifestations: hands | ulnar devn; swan neck deform (PIP hyperext), boutonniere (PIP hyperflex & DIP hyperext) |
RA: Articular manifestations: feet | affected in 90% of pts w/ longstanding RA; subluxation of MTP joints leads to callus formation |
RA: Articular manifestations: wrists | in most pts; radial deviation; inc synovial proliferation leads to median n. compression, tendon rupture |
RA: Articular manifestations: other joints: | any synovial joint can be affected; TMJ, cricoarytenoid, sternoclavicular joints |
RA: Articular manifestations: c-spine: | C1-C2 articulation; atlantoaxial subluxation is feared complication (d/t ligamentous laxity induced by synovial prolif) |
RA atlantoaxial subluxation presenting sxs: | pain radiating up occiput; slowly prog quadriparesis w/ inc sensation in hands; UE paresis triggered by head movements; transient episodes of vert art compression |
RA: joints most commonly affected | MCP, PIP, wrists, knees, shoulders |
RA: Labs | no single dx test confirms RA; acute phase reactants (ESR, CRP, thrombocytosis); autoAbs (RF, anti-CCP, ANA); anemia of chronic dz; synovial fluid analysis; inc WBCs, mostly PMNs |
RF testing | RF result changes over time (some: seroneg RA) (so if neg, sd test periodically later) |
Lab results: Ro, La, Smith, & RNP: | don’t change over time |
RA labs: CCP | more specific for RA than RF; 30% RA pts are RF neg; 60% RA pts CCP pos; CCP pos at risk for severe dz |
RA Imaging: | must ID changes early (avoid irreversible joint damage); sig amt genl skeletal bone lost early in dz |
RA: prevalence of osteoporosis = | 2x that of general population |
RA Imaging: early findings: | soft tissue swelling, peri-articular osteopenia, marginal erosions |
RA Imaging: late findings: | diffuse osteopenia, joint space narrowing, deformities |
RA Tx: mod-severe dz at dx: | start with DMARDs (combo tx); titrate dose upward as needed; add biologic tx for uncontrolled joint pain, swelling |
RA Tx: mild dz: | less aggressive DMARDs (hydroxychloroquine, sulfasalazine) |
RA Tx: adjuncts: | glucocorticoids, NSAIDS, analgesics, PT / occupational tx |
RA complications: | Inc risk of CV disease: premature, accelerated atherosclerosis 2nd to chronic inflame; Inc rate of malig (usu lymphoma); atlantoaxial subluxation |
Felty’s syndrome: | rare: RA & splenomegaly, leukopenia & recurrent pulmonary infxn; poss also leg ulcers, vasculitis |
Baker’s cyst: | rupture of synovial fluid from knee into calf; mimics DVT, cellulitis |
RA: Predictors of poor prognosis: | low functional score, low SES, inc ESR, CRP, early radiographic changes |
RA: Plain films show joint damage after: | 2 years of dz duration in 70% of cases |
RA: MRI scans reveal: | erosive joint damage as early as 4 months |
RA: Primary care mgmt: | disability; med AE (edema); surveil for infxn, malig, osteoporosis, depression; immunizations; CV risk reduction |
Joints most affected by RA | ankles, wrists, shoulders |
RA pathogenesis | Genetics: both susceptibility & dz severity; HLA-DR 1 and DR4 alleles |
RA: Poss infectious triggers: | Mycoplasma, Mycobacterium, enteric bacteria; rubella, parvovirus B19, EBV |
RA Clinical manifestations: | slow, insidious onset; sxs wks to mos; fatigue, malaise, low-grade fever, wt loss; joints typically swollen (boggy) and/or warm; erythema uncommon |
RA classic presentation: | small bones of hands/feet, usu affected early (PIPs, MCPs, MTPs); progression to larger joints (wrists, knees, elbows, ankles, hips, shoulders) |
Created by:
Abarnard
Popular Medical sets