Rheumatoid Arthritis - Clinical

Question 1

Symptoms of Rheumatoid Arthritis

Answer 1

Hand joint pain
Morning joint stiffness for more than 30 minutes
Symptoms improve throughout the day
Joint swelling
Knee effusions
Bilateral swollen ankle
Raised ESR, CRP

Question 2

Investigation/Review for RA Patient

Answer 2

Confirm widespread synovitis
Positive RF
Positive anti CCP antibody
Baseline hand and foot x ray

Question 3

Treatment for RA

Answer 3

Glucocorticoids
Initiation of DMARD therapy
Patient information

Question 4

Example of DMARD therapy

Answer 4

Sulfasalazine

Question 5

Describe what is involved in an RA follow-up

Answer 5

Monthly appointments in Early Arthritis Clinic (nurse-led)

• Monitor disease activity DAS28
• Monitor blood test
• Patient education
• Multidisciplinary assessment

Question 6

What HCPs are involved in an RA MDT?

Answer 6

Specialist nurse
OT
Physio
Pharmacist
Clinical Psychologist
Podiatrist
Orthotics

Question 7

What treatment can be given if patient experiences flare ups after initial DMARD therapy?

Answer 7

IM Steroid
Methotrexate
Biologics

Question 8

What is assessed prior to initiating biologic treatment?

Answer 8

TB Vaccination scar
Chest x-ray
Chronic blood-borne viral screening
VZV Serology

Question 9

Example of biologic used to treat RA

Answer 9

Anti-TNF alpha

Question 10

What are the complications of RA?

Answer 10

Orthopaedic complications
Extra-articular involvement
Cardiovascular risk
Socioeconomic implications

Question 11

What orthopaedic complications can occur due to RA?

Answer 11

Chronic synovitis
Pain
Deformities
Poor function
Secondary osteoarthritis

Question 12

Three examples of extra-articular involvement due to RA

Answer 12

Rheumatoid nodules
Interstitial lung disease
Vasculitis

Question 13

Management of Functional Impairment associated with RA

Answer 13

Vertebral fractures (can occur with OA)
Special adaptive cutlery
Adaptive footwear
Walking aids
Wheelchair
Family support
Care package

Question 14

ARA 1987 Criteria for diagnoses of RA (7 points)

Answer 14

Morning stiffness
Arthritis of 3 or more joint areas
Arthritis of hand
Symmetric arthritis
Rheumatoid nodules
Serum Rheumatoid Factors
Radiographic change

Question 15

EULAR/ACR 2010 Criteria for RA diagnosis

Answer 15

6 or more of 
Joint involvement - one large joint/2-10 small joints/ 1-3 small/4-10 small/greater than 10 
Serology
Acute Phase Reactants
Duration of Symptoms

Question 16

2 factors to be eligible for investigation of RA under EULAR/ACR criteria

Answer 16

Definite clincal synovitis

Swelling cannot be explained by another illness

Question 17

Ratio of RA Male to Female

Answer 17

1 to 3

Question 18

Average age to be diagnosed with RA

Answer 18

Presents 4th/5th decade

Question 19

Genetic and environmental factors contributing to RA

Answer 19

Smoking
Chronic infection
HLA DRB 1

Question 20

Investigations for RA

Answer 20

Rheumatoid Factor - IgG, IgM

Anti CCP antibodies , ACPA

Question 21

Symptoms of RA

Answer 21

Pain 
Stiffness
Immobility
Function
Systemic symptoms

Question 22

Signs of RA

Answer 22

Swelling
Tenderness
Limitation of movement
Redness 
Heat

Question 23

Non-specfic systemic features of RA

Answer 23

Weight loss
Fatigue
Anaemia

Question 24

Specific systemic symptoms of RA

Answer 24

Eyes 
Lungs
Nerves
Skin - nodules
Kidneys

Question 25

Long-term associations and risks of RA

Answer 25

Cardiovascular

Malignancy

Question 26

Assessment of RA - Disease Activity Score (DAS)

Answer 26

<2.4 Clinical remission

>5.1 eligible for biologic therapy

Question 27

4 Treatment approaches of inflammatory Arthritis

Answer 27

Medicines
Injections
Therapies
Surgeries

Question 28

Therapeutic categories for RA treatment

Answer 28

NSAIDs
DMARDs
Biologics
Corticosteroids

Question 29

4 examples of DMARDs

Answer 29

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide

Question 30

Treatment strategies for early aggressive intervention

Answer 30

Sequential Monotherapy
Combination
Targeted Therapy

Question 31

Mechanism of Biologics

Answer 31

Target aspects of inflammatory cascade

Question 32

Examples of Biologics

Answer 32

Anti TNF alpha
IL-1 inhibitors
Anti B cell therapies - Rituximab
Anti T cell therapy - Abatacept
IL-6 inhibitors - Tocilizumab

Question 33

Biologic therapy will have an enhanced effect in RA in conjunction with which other medication?

Answer 33

Methotrexate -DMARD

Question 34

Methods of Corticosteroid administration

Answer 34

Oral, IV, IM

Question 35

What factors need considered when prescribing corticosteroids?

Answer 35

Short term benefit versus long term toxicity

Inappropriate as single drug therapy in most cases