part 1 RA sem1

FILL IN THE BLANKS!

Characteristics of RA

• Autoimmune disorder – body attacks its own surrounding/tissues

• More common in Female (_____ y/o) – affecting _____ joints

  • Early onset

  • Affecting the _____ joints

• If male (_____y/o) – _____ joints are affected

  • E.g. shoulder, hip

• Type of arthritis: _____ – causes erosion in the joint

  • _____ – causes erosion

• RA is inflammatory (disabling), chronic, and systemic

  • _____ – affects other parts of the body, not only the joints but also the blood, eyes, etc.

FILL IN THE BLANKS!

Characteristics of RA

• Autoimmune disorder – body attacks its own surrounding/tissues

• More common in Female (30-45 y/o) – affecting small joints

  • Early onset

  • Affecting the distal joints

• If male (60y/o) – larger joints are affected

  • E.g. shoulder, hip

• Type of arthritis: Erosive – causes erosion in the joint

  • Nodules – causes erosion

• RA is inflammatory (disabling), chronic, and systemic

  • Systemic – affects other parts of the body, not only the joints but also the blood, eyes, etc.

Dx

• ______

  • Series of antibodies

  • IgM and IgG is recognized as their antigen

• ______ – associated with poor prognosis, increased extraarticular manifestation, severe disease

• ______, if seronegative – may cause immune system disruption

  • not only limited to RA but can be seen in other conditions

• ______ – proliferation involving the synovium of the diarthrodial joints

  • Formation of T-cell proliferation is called ______

  • ______ causes erosion

  • ______ – responsible for killing foreign bodies inside the body

Dx

• (+) Rheumatoid factors (RF)

  • Series of antibodies

  • IgM and IgG is recognized as their antigen

• Seropositive Rheumatoid Factor – associated with poor prognosis, increased extraarticular manifestation, severe disease

• (+) HLA DR4, if seronegative – may cause immune system disruption

  • not only limited to RA but can be seen in other conditions

• T-Cell – proliferation involving the synovium of the diarthrodial joints

  • Formation of T-cell proliferation is called Pannus Formation

  • Pannus formation causes erosion

  • Pannus formation are T-cells – responsible for killing foreign bodies inside the body

Dx

• ______

  • Series of antibodies

  • IgM and IgG is recognized as their antigen

Dx

• (+) Rheumatoid factors (RF)

  • Series of antibodies

  • IgM and IgG is recognized as their antigen

Dx

• ______ – associated with poor prognosis, increased extraarticular manifestation, severe disease

Dx

• Seropositive Rheumatoid Factor – associated with poor prognosis, increased extraarticular manifestation, severe disease

Dx

• ______, if seronegative – may cause immune system disruption

  • not only limited to RA but can be seen in other conditions

Dx

• (+) HLA DR4, if seronegative – may cause immune system disruption

  • not only limited to RA but can be seen in other conditions

Dx

• ______ – proliferation involving the synovium of the diarthrodial joints

  • Formation of T-cell proliferation is called ______

  • ______ causes erosion

  • ______ – responsible for killing foreign bodies inside the body

Dx

• T-Cell – proliferation involving the synovium of the diarthrodial joints

  • Formation of T-cell proliferation is called Pannus Formation

  • Pannus formation causes erosion

  • Pannus formation are T-cells – responsible for killing foreign bodies inside the body

Dx

• ______ – proliferation involving the synovium of the diarthrodial joints

Dx

• T-Cell – proliferation involving the synovium of the diarthrodial joints

Dx

• Formation of T-cell proliferation is called ______

Dx

• Formation of T-cell proliferation is called Pannus Formation

Dx

• ______ causes erosion

Dx

• Pannus formation causes erosion

Dx

• ______ – responsible for killing foreign bodies inside the body

Dx

• Pannus formation are T-cells – responsible for killing foreign bodies inside the body

In RA’s Diagnostic Criteria, enumerate the 7 main components

1. Morning stiffness a. Inflammation >1 hour b. Non-inflammatory (OA) <30 mins

2. Arthritis on 3 or more joints

3. Hand arthritis (can be asymmetrical)

4. Symmetrical

5. Rheumatoid/ subcutaneous nodules

6. Erosion in x-ray (d/t Pannus formation)

7. (+) RH Factor

In RA’s Diagnostic Criteria, enumerate what you’ll find in x-ray

o A - Abnormal alignment

o B – Bone involvement

o C – Cartilage involvement

o D – Deformities

o E – Erosion

o S – Soft tissue Swelling

Most common affected joints: it will never involve the _____

o _____ – MC affected

o _____

o _____

Most common affected joints: it will never involve the DIP

o MCP – MC affected

o Wrist

o PIP

What are the common conditions associated with Rheumatoid Arthritis?

Common Conditions

o Swan-neck deformity

o Boutonniere deformity

o Ulnar drift

subluxation of extensors, particularly ECU, because of tendon rupture of the extensor tendon. Particularly affects 4th and 5th finger

o Vaughn Jackson Deformity –

flexor pollicis rupture from adhesion caused by bony spur in the carpal tunnel. Common in the 4th finger

o Mannerfelt syndrome –

Enumerate the Extraarticular manifestations

1. Heart – Pericarditis

2. Lungs – Caplan’s syndrome “ capLUNGS”

a. Rheumatoid nodules found in the lungs

3. Eyes - Sicca syndrome – dryness of the eyes

4. Nerves

a. Median, most common – CTS

b. Ulnar – Cubital Tunnel syndrome

c. Post. Tibial n. – tarsal tunnel syndrome

d. Radial – Posterior interosseous n. (PIN)

Extraarticular manifestations

Heart

Pericarditis

Extraarticular manifestations

• What do you call the condition associated with Lungs?

Caplan’s syndrome

a. Rheumatoid nodules found in the lungs

Extraarticular manifestations

• What do you call the condition associated with Eyes, where they get dry

Sicca Syndrome (dryness of eyes)

Extraarticular manifestations

• What nerves are affected here?

  • ____ most common in CTS

  • ____ Cubital Tunnel Syndrome

  • ____ Tarsal Tunnel Syndrome

  • _____ Posterior Interosseous Nerve

Extraarticular manifestations

• What nerves are affected here?

  • MEDIAN NERVE most common in CTS

  • ULNAR NERVE Cubital Tunnel Syndrome

  • POSTERIOR TIBIAL NERVE Tarsal Tunnel Syndrome

  • RADIAL NERVE Posterior Interosseous Nerve

What condition is this?

• A syndrome secondary to RA

• Other names

  • Gougerot’s

  • Mikulicz’s

  • Autoimmune exocrinopathy

• Triad of Sjogrens (DAD)

  • D – dry eyes

  • A – arthritis

  • D – dry mouth

• Manifestations

  • Dyspareunia – painful sexual intercourse, secondary to dryness of female genitalia

Sjogren’s Syndrome

What is the Triad of Sjogren’s Syndrome?

o D – dry eyes

o A – arthritis

o D – dry mouth

A manifestation of Sjogren’s Syndrome that is defined as painful sexual intercourse, secondary to dryness of female genitalia

Dyspareunia

What condition is this?

• A blood condition that leads to arthritis

• Blood is SLLAANT

  • S – splenomegaly – enlarged spleen

  • L – leukopenia – decreased leukocytes (low WBC)

  • L – lymphadenopathy

  • A – arthritis

  • A – anemia

  • N – neutropenia – low count of neutrophils

  • T – thrombocytopenia – decreased thrombocytes

Felty’s Syndrome

Enumerate the characteristics of blood in Felty’s Syndrome

• Blood is SLLAANT

  • S – splenomegaly – enlarged spleen

  • L – leukopenia – decreased leukocytes (low WBC)

  • L – lymphadenopathy

  • A – arthritis

  • A – anemia

  • N – neutropenia – low count of neutrophils

  • T – thrombocytopenia – decreased thrombocytes

Enumerate the Stages of Rheumatoid Arthritis

Stage 1 Early

Stage 2 Moderate

Stage 3 Severe

Stage IV Terminal

What stage is this in Rheumatoid Arthritis?

o (+) Juxtaarticular osteoporosis,

o (-) bone destruction, deformity, and extraarticular manifestations.

Stage I Early

What stage is this in Rheumatoid Arthritis?

o (+) juxta articular osteoporosis, with or without slight bone destruction,

o Rheumatoid nodules (signs of progression to severe stage)

o Adjacent muscle atrophy

Stage II Moderate

What stage is this in Rheumatoid Arthritis?

o (+) deformities> LOM

o (+) extraarticular manifestations, Rheumatoid nodules, tenosynovitis,

o Extensive muscle atrophy

Stage III Severe

What stage is this in Rheumatoid Arthritis?

o All of the above

o (+) ankylosis (bony fusion)

Stage IV Terminal

Enumerate the Functional Classification of Rheumatoid Arthritis

Class 1

Class 2

Class 3

Class 4

What Functional Classification is this in Rheumatoid Arthritis?

• Independent in all activities

Class I

What Functional Classification is this in Rheumatoid Arthritis?

• Independent in Self-care and vocational

• Limited in avocational activities

Class II:

What Functional Classification is this in Rheumatoid Arthritis?

• Independent in self-care

• Limited in vocational and avocational activates

Class III

What Functional Classification is this in Rheumatoid Arthritis?

• Dependent in all activities

Class IV:

What type of RA is this?

• Common on elderly female 50 years old

• Pain and stiffness in the muscles

• Common in shoulder girdle and neck muscles affected

• Common affected knee joint

• Low grade fever

• Muscle pain > joint pain

• Mnemonics: SECRET

→ Ang secret ni lola poly:

o S – Stiffness

o E – Elderly

o C – Caucasian

o R – Rheumatism (knee joint)

o E – Elevation of ESR – inflammatory response ongoing in the body (inflammation) 60-100mm/hr

o T – Temporal Arteritis (Giant Cell Arteritis)

Polymyalgia Rheumatic

What does SECRET stand for in Polymyalgia Rheumatic?

o S – Stiffness

o E – Elderly

o C – Caucasian

o R – Rheumatism (knee joint)

o E – Elevation of ESR – inflammatory response ongoing in the body (inflammation) 60-100mm/hr

o T – Temporal Arteritis (Giant Cell Arteritis)

What are the types of Juvenila Rheumatic Arthritis?

Pauciarticular/ Oligoarticular

Polyarticular

Systemic/ Still’s disease

A type of Juvenila Rheumatic Arthritis

• <4 joints; for the first 6 months KAW (knee ankle wrist) +TMJ

• F>M 5 y/o

• If 1 more joint is added after 6 months it is called Extended Pauciarticular JIA

• 2 types

  • (+) ANA (antinuclear antibody) and (+) iridocyclitis (most disabling involvement of the eye) – unequal size of the pupils))

  • (-) ANA -

Pauciarticular/ Oligoarticular (Most common type)

In Pauciarticular / Oligoarticular, if 1 more joint is added after 6 months, it is called what?

Extended Pauciarticular JIA

What are the 2 types of Pauciarticular/ Oligoarticular?

a. (+) ANA (antinuclear antibody) and (+) iridocyclitis (most disabling involvement of the eye) – unequal size of the pupils))

b. (-) ANA -

A type of Juvenile Rheumatic Arthritis

• more than 5 joints affected

• Aka polyarthritis

• F>M 8 y/o

• Affects the small joints of the hands

• 2 types

  • (+) RF Adult like RA

  • (-) RF

Polyarticular –

A type of Juvenile Rheumatic Arthritis

• Most rare among the 3

• F=M

• Most Severe type

• High grade fever, daily, od

• Still’s Rash in the presence of fever (salmon –pink)

• Disappears with depression of fever

• Nonpruritic rash – not itchy

Systemic/ Still’s disease