Clinical Aspects of RA

Question 1

What is the prevelance of rheumatoid arthritis (RA)?

Answer 1

• Approximately 1% of population have RA
• Females: Males 3:1
• Peak age of onset is 4th/5th decade

Question 2

What is the presentation of a patient with RA?

Answer 2

• Pain
• Stiffness
• Immobility
• Poor function
• Systemic Symptoms

Question 3

How is RA diagnosed?

Answer 3

Immunology:

• Rheumatoid Factor (IgG, IgM)
• Anti cyclic citrullinated Antibodies (Anti CCP, ACPA)

Question 4

What are classic patient symptoms of RA?

Answer 4

• Pain
• Stiffness
• Immobility
• Poor function
• Systemic symptoms

Question 5

What are the clinical signs of RA?

Answer 5

• Swelling
• Tenderness
• Limitation of movement
• Redness
• Heat

Question 6

What are the most commonly seen systemic symptoms associated with RA?

Answer 6

• Fatigue
• Weight loss
• Anaemia
• Eyes
• Lungs
• Nerves
• Skin

Question 7

How is the severity of RA assessed in patients?

Answer 7

• Disease Activity Score (DAS)
• < 2.4 represents clinical remission
• > 5.1 represents eligibility for biologic therapy

Question 8

What are the major cell types involved in RA?

Answer 8

• T lymphocytes
• Macrophages

Question 9

What is the major pathological process occuring in RA?

Answer 9

• Synovitis (inflammation of the synovial membrane)
• Inflammation causes pannus (granulation tissue) to form at the edge of the synovial membrane
• The pannus causes tissue damage and starts to disintengrate the bone and cartilage
• As bone and cartilage disintegrate, calprotectin levels rise which act as a useful biomarker