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Rheumatology - Phase II > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

What markers are raised in RA?

A 
Anti CCP (Specific)
Rheumatoid Factor (Non specific)
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2
Q

What are some of the arthritic features of RA?

A 
Symmetrical
Polyarthritis
Smaller joints - MCPs, PIPs of hands and feet
Pain 
Swelling
Deformity
Prolonged morning stiffness (>1hr)
Eases with exercise
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3
Q

What are some of the deformities associated with RA?

A

Swan neck - (DIP hyperflexion with PIP hyperextension)
Boutonniere - (PIP flexion with DIP hyperextension
Z - Thumb
Ulnar deviation of fingers
Dorsal subluxation of ulnar styloid

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4
Q

Describe the nodules associated with RA

A

Called rheumatoid nodules
Firm, non tender. Can be mobile or fixed
Commonly occur on the elbows, fingers and lungs

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5
Q

What are some of the other signs of RA in the hands? Excluding deformity, pain and nodules

A

Carpal tunnel syndrome
Raynaud’s syndrome
Tenosynovitis eg De Quervain’s (Effects tendons on lateral side of wrist near to thumb)

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6
Q

What are some of the immune complications of RA?

A

Lymphadenopathy
Amyloidosis
Vasculitis

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7
Q

What are some of the cardiac complications of RA?

A

Pericarditis

Pericardial effusion

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8
Q

What are some of the pulmonary complications of RA?

A 
Rheumatoid nodules in the lung
Fibrosing alveolitis (Lower zones)
Pleural effusions (Exudate)
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9
Q

What are some of the opthalmic complications of RA?

A

Scleritis/Episcleritis

Secondary Sjogren’s Syndrome

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10
Q

What is Felty’s syndrome?

A

RA + Splenomegaly + Neutropenia

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11
Q

What is the diagnostic criteria for RA?

A 
Need 4/7 of;
Morning stiffness >1hr, >6 weeks
Arthritis >3 joints
Arthritis of hand joints
Symmetrical
Rheumatoid nodules
\+ive Rheumatoid factor
Radiographic changes
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12
Q

What diseases can cause a microcytic anaemia?

A 
RA
DM
RCC
Hepatoma
Polymyalgia rheumatica 
*Iron deficiency is the most common cause*
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13
Q

What investigations can be done in a patient with suspected RA?

A

FBC - Anaemia, Raised CRP/ESR, Raised platelets
70% have +ve RF, if -ve called seronegative rheumatoid
High titre RF associated with severe disease
Anti CCP
ANA +ive in 30%
X-Ray
USS
MRI

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14
Q

What is the conservative management of RA?

A

Physiotherapy
Occupational therapy - Splints, Aids
Referral to rheumatologist - earlier the better as DMARDs can slow progression, only prescribed by specialists
Regular exercise

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15
Q

How can you monitor RA?

A

DAS28
RF
X-Rays

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16
Q

What is the medical management of RA?

A 
DMARDs
Biologics
*Use early!*
NSAIDs
Steroids if exacerbations once reviewed by rheumatologist
17
Q

What is important when managing a RA patient?

A

To manage their CV risk as well as RA accelerates the development of atherosclerosis

18
Q

What is the surgical management of RA?

A

Ulna stylectomy

Joint prosthesis

19
Q

What are the common side effects of all DMARDs?

A

Myelosuppression causing Pancytopenia

20
Q

What are the side effects of Methotrexate?

A

Hepatotoxic
Pulmonary fibrosis
Highly teratogenic

21
Q

What is the mode of action of Methotrexate?

A

Interferes with purine metabolism causing to accumulation of adenosine, inhibiting T cells and B cells
Interferes with folic acid and DHFR - Not main action in RA
Given once a week

22
Q

What are the side effects of Sulfasalazine?

A

Hepatotoxic
Decreased sperm count
Stevens johnson syndrome

23
Q

What is the mode of action of Sulfasalazine?

A

Metabolises the Mesalazine (5-ASA/5-aminosalicylic acid)
Mode of action not understood
Can be used in pregnancy

24
Q

What are the two compunds combined to make Sulfasalazine?

A

Sulfapyridine (Antibiotic compound)

Salicylate (Anti-inflammatory compound)

25
Q

What are the side effects of Hydroxychloroquine?

A

Retinopathy
Seizures
Not recommended in pregnancy

26
Q

What is the mode of action of Hydroxychloroquine?

A

Reduces the activation of dendritic cells and the inflammatory process
Can also be used to treat malaria

27
Q

What are some of the other DMARDs?

A

Gold - Can cause nephrotic syndrome

Penicillamine - Taste change, drug induced lupus

28
Q

When are biologics prescribed?

A

In severe RA when there is no response to DMARDs

Need to screen for TB first as Anti TNF so will cause activation of TB if present

29
Q

What are some of the side effects of biologics?

A

Increased infections - TB, opportunistic, Sepsis
Increased risk of lymphoma
Increased risk of some neurological diseases

30
Q

What are some of the commonly used bioloigics?

A

Infliximab (Anti TNF)
Rutiximab (Anti CD20)
Adalimumab (Anti TNF)

31
Q

What are the differentials for RA?

A

Psoriatic arthritis (Nail changes, Plaques)
Jaccoud’s arthropathy (Deforming, non errosive)
Chronic crystal arthropathies

32
Q

What are the radiographic changes of RA?

A

Soft tissue swelling
Peri-Articular osteopenia
Deformity/Subluxation
Reduced joint space

Rheumatology - Phase II (14 decks)

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