Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is inflammatory arthritis?

A

Clearly defined group of conditions where there is tendon or joint inflammation and abnormal blood results and x-rays, rapidly destructive if untreated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does rheumatoid arthritis present?

A

Pain and stiffness in small joints (usually hands and feet), reduction in grip strength, rapid onset, swelling of affected joints, usually symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who gets rheumatoid arthritis?

A

Affects women three times more commonly than men, can affect any age group, UK prevalence is about 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are potential triggers of rheumatoid arthritis?

A

Infections and cigarette smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What determines the severity and course of rheumatoid arthritis?

A

Genetic factors and presence of antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the main structure involved in rheumatoid arthritis?

A

The synovium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the synovium?

A

Lines synovial joint capsules and tendon sheaths, makes direct contact with the synovial fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do susceptibility genes cause?

A

Conversion of arginine into citrulline = causes protein unfolding due to loss of positive charge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What acts as an antigen in rheumatoid arthritis?

A

Unfolded protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What recognises citrullinated proteins?

A

Anti-citrullinated peptide antibodies (anti-CCP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do anti-CCP antibodies do?

A

Distributed through circulation and form immune complexes with citrullinated proteins produced in the inflamed synovium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the immune complexes formed between anti-CCP antibodies and citrullinated proteins associated with?

A

Infiltration and activation of neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the categories in the 2010 ACR/EULAR classification criteria for rheumatoid arthritis?

A

Joint distribution, serology, symptom duration, acute phase reactants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What score on the 2010 ACR/EULAR classification criteria indicates definite rheumatoid arthritis?

A

> =6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What inflammatory markers should be measured in rheumatoid arthritis?

A

CRP, ESR/PV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the clinical features of rheumatoid arthritis?

A

Prolonged morning stiffness (> 30mins)
Involvement of small joints of hands and feet (PIP, MCP, MTP)
Symmetrical
Positive compression tests of MCP and MTP joints
Synovitis = warm, soft joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What antibodies can be measured to investigate rheumatoid arthritis?

A

Rheumatoid factor, anti-CCP antibodies

18
Q

What are some features of rheumatoid factor as a diagnostic test?

A

Sensitivity 50-80%, specificity 70-80%, not very useful

19
Q

What is the sensitivity and specificity of anti-CCP antibodies?

A 
Sensitivity = 60-70%
Specificity = 90-99%
20
Q

What are some features of anti-CCP antibodies?

A

Can be present several years prior to articular symptoms, correlates with disease activity, remains positive despite treatment

21
Q

What are some associations of anti-CCP antibodies?

A

More likely to be associated with erosive damage, linked to current or previous smoking history

22
Q

Can rheumatoid arthritis occur in the absence of anti-CCP antibodies?

A

Yes = seronegative rheumatoid arthritis

23
Q

What are some features of rheumatoid arthritis x-rays?

A

Early disease = normal, soft tissue swelling, periarticular osteopenia
Late disease = erosions, subluxation

24
Q

What are some features ultrasound scans of rheumatoid arthritis?

A

Increased sensitivity for synovitis in early disease
Consistently superior to clinical examination
Can detect more MCP erosions than plain x-ray in early disease
Useful in making treatment changes

25
Q

What is the most common extra-articular manifestation of rheumatoid arthritis?

A

Interstitial lung disease

26
Q

What are some common extra-articular manifestations of rheumatoid arthritis?

A

Increased CV risk, osteopenia/osteoporosis, eye problems, rheumatoid nodules

27
Q

What are some key features of rheumatoid arthritis management?

A

Early recognition and diagnosis
Early treatment with DMARDs
Importance of tight control with target of remission or low disease activity

28
Q

Can rheumatoid arthritis be reversed once there has been joint erosions?

A

No = damage is irreversible

29
Q

What are some side effects of DMARDs?

A

Bone marrow suppression, infections, liver function derangement, pneumonitis, nausea

30
Q

What are some examples of DMARDs?

A

Methotrexate, sulfasalazine, leflunomide, hydroxychloroquine

31
Q

What is the first choice DMARD in most patients?

A

Methotrexate

32
Q

How long does it take methotrexate to begin taking effect, and how is it taken?

A

Takes about 6 weeks to start working; can be given orally or subcutaneously, often used in combination

33
Q

What does methotrexate’s teratogenic properties mean for patients?

A

The drug must be stopped at least three months in female before the patient tries to conceive

34
Q

What is required with methotrexate use?

A

Regular blood monitoring

35
Q

What are some examples of anti-TNF agents?

A

Infliximab, etanercept, adalimumab, certolizumab, golimumab

36
Q

What are some examples of biologic agents?

A 
Anti-TNF drugs
Abatacept = T cell receptor blocker
Rituximab = B cell depletor
Tocilizumab = IL-6 blocker
Tofacitinib/baricitinib = JAK inhibitor
37
Q

What are the criteria for prescribing biologic agents in the UK?

A

Patient hasn’t responded to two different DMARDs

DAS 28 score > 5.1

38
Q

What is the DAS 28 score?

A

Criteria used to assess rheumatoid arthritis disease activity

39
Q

What are some side effects of biologic agents?

A

Risk of infection (especially TB), increases risk of skin cancer, contra-indicated in pulmonary fibrosis and heart failure

40
Q

How are steroids used in the treatment of rheumatoid arthritis?

A

Used as bridging therapy and for flares of disease only

Musculoskeletal (57 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions