Systemic inflammation - Clinical RA

Question 1

RA OVERVIEW

i) what % of world pop does it affect?
ii) what is it?
iii) is it more common in men or women? what is peak age of onset?
iv) what % genetic suscep?

Answer 1

i) affects 0.5-1% work pop
ii) chronic, multi system inflam condition

iii) more common in women
- peak onset 45-65 yrs

iv) 30% genetic suscep

Question 2

JOINT DAMAGE IN RA

i) what is the usual distribution of damaged joints?
ii) is there stiffness at specific times of day?
iii) which signs are seen in the joints (4) are they functional?
iv) what process happens to the joints? what happens to synovium and cartilage?

Answer 2

i) multiple joints in a symmetrical distribution
ii) morning stiffness >1hr
iii) see swelling, heat, redness and pain
iv) bone erosion and synoval/cartilage damage

Question 3

SYMPTOMS AND SIGNS

i) is onset usually acute or chronic?
ii) what pattern of pain is seen?
iii) how is the person systemically? name three things that may be seen
iv) name three things looked for in examination
v) which other symptoms should be looked for?

Answer 3

i) can be either
ii) inflammatory pattern of pain

iii) person is systemically unwell
- may see fatigue, weight loss, malaise, temperature

iv) look for pain, swelling, restriction of movement
v) look for extra articular symptoms as RA is a systemic disease

Question 4

SYNOVITIS

i) what is it? name three places swelling is seen?
ii) what is seen in relation to cell numbers
iii) which cells have reduced apoptosis, upregulated adhesion molecules and increased prolliferation?

Answer 4

i) swelling over extensor tendons, wrist and MCP joints
ii) synovium hyperplasia (inc cell numbers)
iii) synovial fibroblasts

Question 5

RA PATHOPHYSIOL

i) what is seen in relation to lymphocytes?
ii) what reaction is seen?
iii) what happens to cells in the synovium?
iv) what happens to cartilage and bone?
v) what can form over the joint surface?
vi) what is the first joint component to be affected?
vii) what is the most common risk factor?

Answer 5

i) lymphocytic infiltration of the synovium
ii) acute inflamm reaction
iii) synovial proliferation
iv) cartilage destruction and bone erosion
v) pannus formation over joint surface
vi) the synovium
vii) smoking

Question 6

MANAGEMENT OF RA

i) what does early treatment allow?
ii) which drugs can be given for short time periods?
iii) which drugs may be injected into the joint?
iv) which other class of drug can be given? give an eg
v) name two biol agents that can be used
vi) name three biological targets for inhibition by drugs

Answer 6

i) early tx allows reduction of inflammation and joint damage
ii) give NSAIDs for a short time
iii) can inject corticosteroids into the joint
iv) can also give DMARDs eg methotrexate
v) Anti TNF (etanercept) and anti B cell (rituximab)
vi) inhibit TNFa, IL-1, IL-6