Rheumatoid Arthritis Overview

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is a primary characteristic of the onset of rheumatoid arthritis?

Insidious onset over weeks to months (correct)

Symmetrical involvement of large joints first

Immediate severe joint damage

Abrupt onset of joint pain and stiffness

Which joints are typically affected first in rheumatoid arthritis?

Shoulder and hip joints

Elbow and knee joints

Distal interphalangeal (DIP) joints

Proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints (correct)

Which of the following is a hallmark symptom of rheumatoid arthritis?

Morning stiffness lasting for hours (correct)

Cold intolerance

Rapid resolution of joint stiffness

Localized joint pain only

Which of the following symptoms is not commonly associated with rheumatoid arthritis?

Joint swelling without pain Signup and view all the answers

What is the male to female ratio typically observed in rheumatoid arthritis?

3:1 Signup and view all the answers

What is a common extra-articular manifestation of rheumatoid arthritis?

Skin rash Signup and view all the answers

Which imaging study is often used to aid in the diagnosis of rheumatoid arthritis?

X-ray Signup and view all the answers

Which type of arthritis is characterized by episodic self-limited attacks?

Palindromic rheumatism Signup and view all the answers

Which of the following is a late-stage manifestation of rheumatoid arthritis in the hands?

Ulnar deviation Signup and view all the answers

What is a common joint involvement pattern in late-stage rheumatoid arthritis?

Symmetric involvement Signup and view all the answers

Which of the following laboratory findings is associated with rheumatoid arthritis?

Thrombocytosis in active disease Signup and view all the answers

Which condition is not a typical extra-articular manifestation of rheumatoid arthritis?

Hypothyroidism Signup and view all the answers

What is the main purpose of glucocorticoids in the treatment of rheumatoid arthritis?

Aggressively modify disease progression Signup and view all the answers

Which imaging study is used to assess atlantoaxial subluxation in rheumatoid arthritis?

MRI of the cervical spine Signup and view all the answers

Which statement about treatment strategies for rheumatoid arthritis is correct?

Aggressive treatment is beneficial in the early stages. Signup and view all the answers

What is the significance of a positive rheumatoid factor in the context of rheumatoid arthritis?

Suggests the possibility of other diseases as well Signup and view all the answers

What is the maximum single weekly dose of Methotrexate for treating rheumatoid arthritis?

25 mg Signup and view all the answers

Which of the following is NOT a characteristic toxicity associated with Methotrexate?

Hypersensitivity Signup and view all the answers

Long-term use of hydroxychloroquine may primarily lead to which serious complication?

Retinal toxicity Signup and view all the answers

Which drug is indicated for treatment in a patient with elevated blood pressure alongside rheumatoid arthritis?

Leflunomide Signup and view all the answers

Which of the following is a common extraarticular manifestation of rheumatoid arthritis?

Pulmonary fibrosis Signup and view all the answers

What is the recommended daily dosage range for Sulfasalazine?

1 g - 3 g Signup and view all the answers

Adult-Onset Still Disease may present with which of the following symptoms?

Daily fever and macular rash Signup and view all the answers

Which small-molecule inhibitor is known to have an increased risk of herpes zoster reactivation?

Baricitinib Signup and view all the answers

Study Notes

Introduction

Rheumatoid Arthritis (RA) is a chronic, systemic autoimmune disease that primarily targets the synovium.

Epidemiology

Affects 1% of the adult population.
Can present at any age, but typically affects women in their late childbearing years.
Female to male ratio is 3:1.

Clinical Findings

Onset: Can be insidious (weeks to months) or fulminant (abrupt onset).
Systemic Symptoms: Fatigue, low-grade fevers (≤38°C), weight loss.
Distribution of Involved Joints: Primarily affects PIP, MCP, and MTP joints. Large joints may be involved later. Spares DIP joints.
Morning Stiffness: Hallmark of inflammatory arthritis. Worst upon arising or after prolonged rest, lasting for hours. Improves with activity and warmth.
Articular Manifestations: Pain, swelling, and stiffness.
- Hands: Synovial proliferation leads to swelling of MCP and PIP joints. Late-stage may lead to ulnar deviation, swan neck deformities, and boutonnière deformities.
- Wrists: Early stage synovial proliferation, late stage carpal tunnel syndrome.
- Feet: MTP joint involvement, subluxation of toes, skin ulceration.
- Large Joints: Involvement is common in late stages, commonly symmetrical.
- Cervical Spine: Atlantoaxial subluxation (MRI cervical spine can help diagnose).

Extra-Articular Manifestations

Rheumatoid nodules.
Vasculitic leg ulcers.
Sjogren's syndrome.
Lung Complications: Interstitial lung disease and Caplan syndrome.

Laboratory Findings

CBC: Anemia of chronic disease, white blood cell count may be increased, decreased (Felty’s syndrome), or normal. Thrombocytosis can occur in active disease.
Acute-Phase Reactants: Elevated ESR and CRP.
Autoantibodies:
- Rheumatoid factor (RF): against IgG.
- Anti-CCP antibodies.
- ANA (30%).
- ANCA (30%).
Synovial Fluid: 5,000-50,000 WBCs/mcL.

Imaging Studies

X-ray: Juxtaarticular demineralization, joint-space narrowing. In late stages, bony erosions, deformities, and subluxation may be seen.
Musculoskeletal Ultrasound: Detects synovitis, erosions, and tenosynovitis.
MRI Cervical Spine: Used to diagnose atlantoaxial subluxation.

Making the Diagnosis

No single finding on physical examination or laboratory testing is diagnostic of RA.

Differential Diagnosis

Many other conditions can mimic RA, including:
- Osteoarthritis
- Gout
- Psoriatic arthritis
- Systemic lupus erythematosus
- Polymyalgia rheumatica
- Infectious arthritis

Treatment

Window of Opportunity: Aggressive treatment with disease-modifying antirheumatic drugs (DMARDs) early leads to better long-term outcomes.
Glucocorticoids: Low-dose prednisone is often used, but not appropriate as monotherapy. Intra-articular injections can be helpful for residual activity in large joints.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Provide symptomatic relief but not a sole therapy for RA.
Synthetic DMARDs:
- Methotrexate: The most effective DMARD, single dose weekly (max 25mg). Folate supplementation required. Monitor blood cell counts, liver function, and creatinine. Toxicities: Oral ulcers, nausea, hepatotoxicity, bone marrow suppression, pneumonitis.
- Hydroxychloroquine: Antimalarial, 200-400 mg daily. Retinal toxicity is a concern.
- Sulfasalazine: 1-3 g daily, hypersensitivity can occur.
- Leflunomide: 10-20 mg, can cause diarrhea, hepatotoxicity, hypertension, and is teratogenic.
Biologic DMARDs: Used in combination with synthetic DMARDs. Increase risk of infection (tuberculosis, hepatitis B).
Janus Kinase (JAK) Inhibitors: Small-molecule inhibitors. Oral administration. Increased risk of herpes zoster reactivation. Examples: Tofacitinib, baricitinib, and upadacitinib.

Adult-Onset Still Disease

Characterized by quotidian fever greater than 39°C.
Other symptoms include evanescent, salmon-colored macular rash, pharyngitis, polyarthralgia, lymphadenopathy, splenomegaly, and serositis.
Laboratory abnormalities: Leukocytosis, elevated acute phase reactants (ESR and CRP), and dramatic increases in serum ferritin.

Key Points

RA is a chronic, systemic autoimmune disease targeting the synovium.
Early diagnosis and aggressive treatment are vital for better outcomes.
Synthetic and biologic DMARDs are essential elements of treatment.
Potential complications include: Joint deformities, extra-articular manifestations, and increased risk of infection.
Regular monitoring is crucial to assess effectiveness and adjust treatment strategies.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores the critical aspects of Rheumatoid Arthritis (RA), including its epidemiology, clinical findings, and common symptoms. Understand how RA affects the joints and the systemic implications of this autoimmune disease. Test your knowledge about its characteristics and manifestations.