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ICC2 > rheumatoid arthritis > Flashcards

rheumatoid arthritis Flashcards

1
Q

what type of arthritis is rheumatoid arthritis ?

A

inflammatory arthritis

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2
Q

which genes have been associated with an increased risk of rheumatoid arthritis?

A

HLA halotypes DR4 and DR1 , patients without the genes cannot get rheumatoid arthritis

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3
Q

what is pannus ?

A

synovial membrane infiltration

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4
Q

which cells produce the RF ?

A

b cells

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5
Q

what is the clinical picture of RA?

A
  • mainly the affection of the small joints of the hand except the DIP
  • symmetrical arthropathy
  • effusion, pain and affection of the hand function
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6
Q

what is the arrangement of the cells in pannus formation ?

A

t-cells and b-cells are in the centre and plasma cells and macrophages in the periphery

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7
Q

what is the most common pattern of presentation in RA?

A

insidious onset affecting the small joints of the hand and feet progressing to the elbows, shoulders and knees

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8
Q

what is the presentation like in 20% of RA cases ?

A

abrupt acute polyarthritis

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9
Q

what is palindromic rheumatism ?

A

variable episodes of polyarthritis ( comes and goes continuously and reaches a point where it doesn’t go anymore)

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10
Q

what are the hand deformities that can be found ?

A

ulnar deviation of the MCP
radial deviation of wrists
boutonniere deformity of fingers
swan-neck deformity of fingers
z-deformity of thumb

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11
Q

what are the characteristics of swan-neck deformity ?

A

PIP joint: hyperextension

DIP joint: flexion

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12
Q

what are the characteristics of boutonniere deformity ?

A

PIP joint: flexion

DIP joint : hyperextension

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13
Q

what is specific about the morning stiffness associated with RA?

A

lasts for more than one hour and usually decreases with movement

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14
Q

what are the extra articular manifestations found in the skin ?

A

formation of nodules which develop at sites of pressure

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15
Q

what are the extra articular features found in the eye ?

A

keratoconjunctivitis sicca ( sjogren’s syndrome )
scleritis
scleromalacia perforans

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16
Q

what are the pulmonary affections associated with RA?

A

pulmonary nodules
pulmonary fibrosis
Caplan’s syndrome

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17
Q

what is the most common cardiac manifestation in RA?

A

pericarditis

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18
Q

what are the renal manifestations associated with RA?

A

renal amyloid

GN ( related to drugs)

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19
Q

what are the neurological complications associated with RA?

A

cervical cord compression (atlanto-axial)
entrapment neuropathies
peripheral neuropathy
mononeuritis multiplex

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20
Q

what is the presentation of mononeurtitis multiplex ?

A

nerve of the foot is affected causing a drop foot

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21
Q

what are the associated haematological manifestations ?

A

normochromic normocytic anemia
thrombocytosis

22
Q

what is felty’s syndrome ?

A

it is an extra-articcular manifestation of serop-positive rheumatoid

SANTA
splenomegaly
anemia
neutropenia
thrombocytopenia
arthritis

23
Q

what investigations would you order if you’re suspecting RA?

A 
CBC 
ESR, CRP 
urea and creatininne, LFTs 
RF
Anti-CCP
24
Q

which Ab is more specific to look for in serology in RA?

A

Anti-CCP

25
Q

what is rheumatoid factor ?

A

made by B-cells and are IgM against the Fcp portion of IgG

26
Q

when is the titre of rheumatoid factor high ?

A

if the patient has :
extra-articular manifestation
nodules
in severe disease

27
Q

can healthy people be positive for RF ?

A

yes

28
Q

what difference inn prognosis is there inn seronegative and seropositive patients ?

A

seropositive patients have a worse prognosis

29
Q

what non-lab investigations would be required ?

A

x-rays

joint aspiration

30
Q

how is a diagnosis of RA made ?

A

presence of RF
CRP and ESR are usually raised
DAS28 is usually raised

31
Q

what are the criteria in the ACR classification of RA ?

A 
morning stiffness lasting at least 1 hour 
swelling in 3 or more joints 
swelling in hand joints 
symmetric joint swelling 
erosion or decalcification on X-ray 
rheumatoid nodules 
abnormal serum RF
32
Q

what is the time period required to make a diagnosis of RA ?

A

at least 6 weeks

33
Q

how many of the ACR criteria are required to make a diagnosis of RA ?

A

4 out of 7

34
Q

with the updated classification of RA what is the number of criteria required to make a diagnosis ?

A

6/10 to overcome the problem of 6 weeks

35
Q

what are the X-ray findings associated with rheumatoid arthritis ?

A

soft tissue swelling
periarticular osteopenia
narrowing of joint space
subluxations and deformities

36
Q

what is the main line of treatment of RA ?

A

DMARDs along with NSAIDs

37
Q

what are the important contraindications associated with NSAIDs ?

A

PUD
renal impairment
Asthma

38
Q

what are the different DMARDs ?

A

methotrexate
hydroxychloroquine and chloroquine
salazopyrin
leflunomide
penicillamine

39
Q

what are the side effects of methotrexate ?

A

hepatotoxic
bone marrow suppression
so monitor liver function and CBC carefully

40
Q

what are the side effects of hydroxychloroquine ?

A

skin pigmentation
retinopathy
myopathy

41
Q

what are the side effects of salazopyrine ?

A

rashes
liver abnormalities

42
Q

what are the side effects of leflunomide ?

A

diarrhoea, alopecia, rash and abnormal liver function tests

43
Q

what immunosuppressants can be used ?

A

azathioprine
cyclophosphamide
cyclosporine

44
Q

what are the side effects of each type of immunosuppressant ?

A

AZA - BM suppression , malignancy
Cyclophosphamide - myelosuppression, gonadal toxicity, hemorrhagic cystitis
cyclosporine - hypertension and creatinine rise

45
Q

what are the biologic drugs for RA ?

A

etanercept
infliximab

46
Q

what must infliximab be given with ?

A

methotrexate

47
Q

what is the first line treatment for adults newly diagnosed with RA ?

A

methotrexate
consider hydroxychloroquine for palindromic disease

48
Q

what is the best treatment to control flaer ups of RA in pregnant women ?

A

hydroxychloroquine
sulfasalazine
along with folate supplementation

49
Q

which DMARDs should be avoidd in pregnancy ?

A

leflunomide
methotrexate

50
Q

before the initiation of biologic treatment what must be screened for first ?

A

mycobacterium TB

ICC2 (42 decks)

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