23 - Clinical Rheumatoid Arthritis

Question 1

M:F?

Answer 1

F>M - 3:1

Question 2

what is peak age of onset?

Answer 2

4/5th decade

Question 3

when can RA be diagnosed?

Answer 3

after 16 yrs old

Question 4

name 2 types of causes of RA?

Answer 4

genetic and environmental

Question 5

how is incidence related to family history?

Answer 5

incidence rises in siblings by 2-4% and in twins by 12-15%

Question 6

how is RA genetically associated with incidence?

Answer 6

Specific amino acid sequences at positions 70-74 of DRB1 (shared epitope)

Question 7

name 2 environmental factors which increases risk of RA?

Answer 7

smoking, chronic infection (e.g. periodontal disease)

Question 8

name 4 types of cells involved in synovial pannus of RA?

Answer 8

T lymphocytes, macrophages, fibroblasts plasma cells, endothelium dendritic cells

Question 9

what cells are present in synovial fluid during RA?

Answer 9

neutrophils

Question 10

name 4 immunological investigations for RA?

Answer 10

rheumatoid factor, ACCA, ESR, CRP

Question 11

what is seen in rheumatoid factor immunology for RA?

Answer 11

IgG and IgM

Question 12

what is seen in ACCA immunology for RA?

Answer 12

CCP, ACPA

Question 13

which imagining should be used to investigate RA?

Answer 13

MRI/ x-ray

Question 14

acronym to remember symptoms of RA?

Answer 14

PIPSS

Question 15

name 5 symptoms of RA?

Answer 15

Pain, Immobility, Poor function, Systemic symptoms, Stiffness

Question 16

3 signs of RA?

Answer 16

swelling, tenderness and limitation of movement

Question 17

3 non-specific symptoms of RA?

Answer 17

anaemia, weight loss, fatigue

Question 18

2 long-term systemic risks associated with RA?

Answer 18

CVS, malignancy

Question 19

severity scoring?

Answer 19

DAS - disease activity score

Question 20

what does DAS <2.4 mean?

Answer 20

clinical remission

Question 21

what DAS score corresponds with eligibility for biologic therapy?

Answer 21

> 5.1

Question 22

how does RA affect life expectancy?

Answer 22

shortens by 7 years

Question 23

how many people have to stop working after 2 years of diagnosis of RA?

Answer 23

~33%

Question 24

how many people have to stop working after 10 years of diagnosis of RA?

Answer 24

~50%

Question 25

when does stiffness of joints typically present?

Answer 25

in morning

Question 26

name 2 radiological changes seen in RA?

Answer 26

erosions, bony decalcification

Question 27

2 types of drugs for RA?

Answer 27

DMARDs and biologics

Question 28

name 4 DMARDs?

Answer 28

methotrexate, leflunomide, hydroxychloroquine, sulfasalazine

Question 29

1st line treatment?

Answer 29

methotrexate with other DMARD/ biologic + corticosteroids

Question 30

name 4 side effects of methotrexate?

Answer 30

nausea, hair loss, sore mouth, diarrhoea

Question 31

monitoring while on methotrexate?

Answer 31

regular bloods (LFTs etc.) and CXR on starting treatment

Question 32

name a biologic?

Answer 32

infliximab

Question 33

when are biologics used?

Answer 33

alongside DMARDs - often to augment their efficacy

Question 34

how are biologics administered?

Answer 34

Injection

Question 35

name 4 potential SEs of biologics?

Answer 35

headaches, infection, irritation @ injection site, high T

Question 36

name 1 serious complication associated with biologics?

Answer 36

reactivation of TB

Question 37

name 2 types of JAK inhibitors?

Answer 37

tofacitinib and baricitinib

Question 38

how are JAK inhibotrs taken?

Answer 38

once/twice daily, either alone or with methotrexate

Question 39

name 4 potential drugs used for pain management in RA?

Answer 39

paracetamol, codeine, ibuprofen and naproxen

Question 40

If given NSAIDs for analgesia, what will you be required to take with these and why?

Answer 40

PIPs - to reduce stomach acid

Question 41

when can steroids be used in RA?

Answer 41

short term relief - e.g. when waiting for DMARDs to take effect

Question 42

name a steroid used in RA?

Answer 42

prednisolone

Question 43

3 SEs of steroids?

Answer 43

thinning of skin, weight gain and osteoporosis

Question 44

name 3 supportive treatments of RA?

Answer 44

physio, podiatry and OT

Question 45

which treatment can be used to remove inflamed joint tissue?

Answer 45

arthroscopy

Question 46

last resort treatment?

Answer 46

joint replacement - arthroplasty