Rheumatoid Arthritis

when is the typical onset of RA

when is the typical onset of RA

40-60

RA risk factors

age, sex (more in females), genetics, obesity, smoking

what is pannus

inflammation that eats its way across a joint

what is the cascade of events that makes up the pathophysiology of RA?

A trigger ramps up production of T-cells → TNF alpha → interleukins → B Cells → RANKL → Osteopeinia

What is RANKL?

inflammatory protein that activates osteoclasts therefore degrading bone

what is seen on an x-ray of someone with RA

decreased bone density (less white appearance), decreased contrast, inflammation, erosion

what is seen on a T2 MRI of someone with RA

inflammation, can detect earlier than an x-ray

what lab findings are indicative of RA?

markers of auto immune dysfunction, markers of systemic inflammation (during active flares)

RA is more of a _______ joint disease

small

what factors contribute to a poorer RA prognosis?

younger age of onset, early bony erosions, swelling in more than 20 joints, high RF or ESR level

what factors contribute to a better RA prognosis?

early identification, beginning DMARDs within 3-5 months of dx

what are the initial symptoms of RA

nonspecific, flu-like w/ some joint involvement

time frame of typical RA presentation

weeks to months

common joint signs and symptoms of RA

redness, swelling, pain, inflammation

does RA typically involve joints on one or both sides of the body?

both

common deformities of the fingers caused by RA

swan neck, boutonniere’s

common deformities of the MCP joints and wrist caused by RA

ulnar drift and radial drift

common deformities of the toes caused by RA

hallux valgus and hammer toes

what part of the spine is sometimes involved in RA

cervical

what do red flags such as weakness, paresthesias, gait abnormalities ect. in all extremities suggest about a person with RA and cervical spine involvement

spinal cord ligament compromise

What is used for medical management of RA?

NSAIDs, Glucocorticoids, DMARDs

would tylenol be used for RA management, why?

no, not anti-inflammatory

what are DMARDs, how do they work

disease modifying anti-rheumatic drugs, they stop disease progression but do not treat pain

designer drugs that target a specific component of the immune system

biologics

surgical management used for RA

arthroplasty (joint replacement) and arthrodesis (joint fusion)

how do PTs asses people with RA?

functional scales, physical performance measures, assessment (pain, ROM, strength, endurance, ect)

is exercise in water as effective as on land for RA?

no, important to be against gravity

what feature differentiate presentation of RA from that of OA?

onset over months not years, typically affects joints bilaterally, redness/swelling of joints, often causes sickness, bicompartmental joint narrowing, systemic