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Lucy Knox - Year 2.5 > 224 - RA > Flashcards

224 - RA Flashcards

1
Q

Where is the primary site of RA?

A

Synovium

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2
Q

What changes occur to the synovium in RA?

A
  • Pannus formation - thickened, inflamed
  • erosion of bone, cartilage and ligament
  • Excess synovial fluid
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3
Q

How common is RA?

A

0.5-1% of population

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4
Q

What risk factors are there for RA?

A

Smoking

Genetic - assoc. with HLA-DR4 and PTPN 22

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5
Q

What is the usual presentation for RA?

A

Gradual onset, in small peripheral joints

Morning stiffness, swelling in joints + hands, symmetrical

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6
Q

What is the pattern of RA joints?

A

Usually PIPs, MCPs and wrist

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7
Q

What changes can be seen in the hand of someone with RA?

A

Ulner deviation of the fingers
Dorsal interosseous wasting
Swan neck deformities
Boutonnier deformity

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8
Q

What can be seen on Xray in RA?

A

Periarticular osteopenia (looks darker)
Periarticular errosions
Reduced joint space
Ulner deviation + subluxation

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9
Q

In RA what are the systemic effects it has?

A

Nodules - s/c gristle
Vasculitis
Cardiac (IHD, pericarditis, valvular disease)
Respiratory (Effusions, fibrosis, nodules)
Haem (Anaemia of chronic disease, thrombocytosis)
Neuro (entrapement neuropathies, atlanto-axial subluxation)
Occular (Episcleritis, scleromalacia)
Amyloidisis - builds up in tissues eg. tongue

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10
Q

How do you diagnose RA?

A

Clincial signs
Bloods - ESR, CRP, Rheumatoid Factor, Anti-CCP
Imaging - US, Xray

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11
Q

Which is better to diagnose RA - RF or Anti CCP?

A

Anti-CCP - more specific to RA (but not as sensitive, only 70% of RA have it)

RF is good as 80% with RA are +ve, but 10% of normal population also +ve

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12
Q

What is the treatment of RA?

A

Analgesia
NSAIDS
Steroids
DMARDS (Methotrexate, Sulphasalazines, Leflunomide)
Biologics (anti-TNF a - infliximab, Anti CD20 - Rituximab)

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13
Q

What characterises connective tissue diseases?

A

Inflammation, Fibrosis, Thrombosis

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14
Q

What are the common symptoms of connective tissue diseases?

A 
Fatigue, malaise, fever
Depression
Arthralgia/myalgia
Weight loss
Lymphadanopathy
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15
Q

What clinical features might be found in someone with connective tissue disease?

A 
Raynauds
Inflammatory arthritis
Skin rashes
Muscle weakness
Pleurisy
Vascular events
Recurent foetal loss
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16
Q

What associations are there with connective tissue disease?

A

HLA

Ethnic susceptibilities

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17
Q

Name 4 connective tissue diseases

A

SLE : systemic lupus erythematosis
Inflam muscle disease - polymyolitis or dermatomyolitis
Scleroderma
Sjorgrens syndrome

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18
Q

What specific signs are there in SLE?

A 
Butterfly rash - photosensitive
Arthritis
Oral ulcers
Alopecia 
Serositis
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19
Q

What are the autoantibodies associated with SLE?

A

ANA (100% +ve),
ds DNA (50% +ve),
anti-sm (15%),
anti-Ro/La (20%)

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20
Q

What treatment options are there for SLE?

A

NSAIDS
Hydroxychloroquine to myalgia
Prednisalone for arthritis

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21
Q

What is scleroderma otherwise known as?

A

Systemic sclerosis

22
Q

What are the features of scleroderma?

A

Fibrotic skin tightening (proximal to elbow)

Can be limited, diffuse or localised

23
Q

In diffuse scleroderma what autoantibody is seen?

A

anti-scl 70

24
Q

What are you at increased risk of with diffuse scleroderma?

A

Pulmonary fibrosis

Renal Crisis

25
Q

What is another name for limited scleroderma? What does it mean?

A 
CREST syndrome
C-alcinosis
R-aynauds
E-osophageal dysmotility
S-clerodactyly
T-alangectasia
26
Q

What autoantibodies are present in limited scleroderma/CREST?

A

Anti-centemere autoantibodies

27
Q

What are the symptoms of Sjorgrens Syndrome?

A

Dry eyes + mouth

Parotid swelling

28
Q

What autoantibodies are seen in Sjorgrens syndrome?

A

Ro (ssa) / La (ssb) autoantibodies
ANA
RF

29
Q

Which connective tissue disease puts you at higher risk for lymphoma?

A

Sjorgrens

30
Q

What is polymyositis?

A

Direct inflammation of the muscle itself

Symmetrical prox muscle weakness

31
Q

What systemic problems can you see with an inflammatory muscle disease?

A

Heliotrope rash - around eyes and eyelids
Guttrons papules - dry scaly skin on knuckles
Mechanics hands - dry scaly skin on tips of fingers

32
Q

What enzyme is elevated in inflammatory muscle disease?

A

CPK - elevated muscle enzyme

33
Q

How do you treat polymyositis?

A

Steroids

Immunosuppressants

34
Q

What is vasculitis?

A

Inflammation within or through a vessel wall - causing an impairment in blood flow + integrity of the vessel - haemorrhage or infarction can occur.

35
Q

What is PMR and what is it associated with?

A

Polymyalgia Rheumatica

Assoc. with GCA - Giant cell Arthritis

36
Q

What are the features of PMR? What age does it affect?

A

Affects middle ages/ elderly
Pain + stiffness in neck, shoulder, pelvic girdle.

Worse in morning, improves with activity

37
Q

What systemic effects are there in PMR?

A

Malaise, weight loss, flue-like

38
Q

What blood tests are raised in Vasculitis?

A

ESR

CRP

39
Q

What is Giant cell arthritis?

A

affects large vessels (with internal elastic components)
eg. aortic arch and branches

Causes: headaches, jaw claudication, fatigue, visual disterbances

40
Q

If Giant cell arthritis is left untreated what are they at risk of?

A

Blindness
Stroke
MI
Necrosis

41
Q

What investigation can be done to confirm giant cell arthritis?

A

Temporal artery biopsy

42
Q

What can be given to treat GCA?

A

High dose prednisolone
Aspirin
Osteoporosis prophylaxis

43
Q

Name 4 types of small vessel vasculitis?

A

Wegners
Polyangiitis
Polyarthritis Nodosa
Churg-Straus

44
Q

What are the general symptoms + systemic effects seen in Small vessel vasculitis?

A

Malaise, fever, weight loss

Skin - purpura, ulcers, infarction
ENT - Epistaxis, sinusitis, deafness
Resp- Cough, haemoptysis, dyspnoea
GI- ulcers, pain, diarrhoea
Neuro - Sensory/motor impairments
Cardiac - chest pain, MI
Renal - Renal failure
45
Q

What investigations are important in small vessel vasculatis?

A 
Inflammatory markets (FBC, ESR, CRP)
ANCA +ve - antineurophil cytoplasmic antibody

(can look for specific antigen involvement, eg. PR3 in wegners)

46
Q

What are the core treatment approaches for small vessel vasculitis?

A

Induce remission - steroids, cyclophosphamide, biologics (anti-TNFs or rituximab)
Maintain remission - Azathioprine, methotrexate, biologics, mycophenolate mofetil (immunosuppressant)

47
Q

What is Wegner’s / Granulomatous polyangiitis

A

Destructive vasculitis, damages midline structures: nose, trachea, lungs, eyes, glomerulonephritis

Assoc with ANCA PR3

48
Q

What is Polyarthritis nodosa?

A 
Rare vasculitis, aneurysms in medium sized vessels
Rash, mononeuritis multiplex
High BP
Testicular pain
GI infarction
49
Q

What is microscopit polyangiitis?

A

Rare vasculitis

ANCA MP0

50
Q

What is churg strauss?

A

Weakly ANCA associated vasculitis
Eosinophilia
Linked to adult onset asthma

51
Q

What is antiphospholipid syndrome?

A

Recurrent vascular thrombosis, pregnancy loss and thrombocytopoemia.

Assoc. with antiphosopholipid antibodies
Treat with warfarin.

Lucy Knox - Year 2.5 (15 decks)

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