Rheumatoid arthritis

Question 1

Arthritis signs and symptoms

Answer 1

pain
stiffness
swelling

restriction of movement
heat and redness
systemic features
restriction of movement

Question 2

Spectrum of RA (6)

Answer 2

• sero negative arthritis
• crystal arthritis (gout and sudo gout)
• connective tissue diseases
• systemic vasculitis
• bone disease
• osteoarthritis

Question 3

What actually is RA?

what is it characterised by

Answer 3

a chronic auto immune systemic illness characterised by a symmetrical peripheral arthritis and other systemic features

Question 4

Classification (7) - not diagnosis but helps to define

Answer 4

1. Morning stiffness
2. Arthritis of 3 or more joint areas
3. Arthritis of hand joints
   At least 1 area swollen (as defined above) in a wrist, MCP, or PIP joint
4. Symmetric arthritis
5. Rheumatoid nodules
6. Serum rheumatoid factor
7. Radiographic changes

Question 5

Classification - diagnosis

Answer 5

• joint involvement
• serology
• acute- phase reactants in blood
• duration of symptoms

Question 6

Aetiology? when does the incidence rise?

what is the genetic contribution said to be?

Answer 6

Genetic factors
1%, 2-4% in siblings and 12-15% in mono twins

Genetic contribution to RA estimated to be ~50-60%

environmental

Question 7

Environmental factors of RA? (2)

Answer 7

Cigarette Smoking

Chronic Infection eg Periodontal disease

Question 8

pathogenesis

Answer 8

T and B cells with cytokines

Question 9

Pathology - joints

Answer 9

inflammation around the synovial membrane - hypertrophy of membrane - inflammation

(SYNOVITIS)

Question 10

RA: Investigation (2)

Answer 10

Immunology
- a Rheumatoid Factor (IgG, IgM) (had more value in the past)

• b) Anti Cyclic Citrullinated Antibodies (anti CCP, ACPA)

Question 11

RA: Investigation - diagnostic tests

Answer 11

X RAYS

- early stages may show normal x–ray

Question 12

Other imaging modalities (2)

Answer 12

MR - lacks flexibility

- diagnostic ultrasound - helps interpret the clinical signs better - will show inflammation (fire like)

Question 13

Symptoms of Arthritis (the symptoms of inflammation) (5)

Answer 13

Pain
Stiffness
Immobility
Poor function
Systemic Symptoms

Question 14

Clinical Signs of Arthritis (5)

Answer 14

Swelling
Tenderness
Limitation of Movement
(Redness)
(Heat)

Question 15

what does RA look like compared to different types (3-4)

Answer 15

• symmetrical
• bilateral , signs similar right to left
• symmetrical poly arthritis
  hands and feet
• peripheral symmetrical poly arthritis - multiple joints are involved

Question 16

Clinical signs in joints (2)

Answer 16

swelling round the joints - knuckles, wrist

synovial swelling - small joints of hand or knee,

Question 17

RA: Clinical (Systemic features) - non-specific (3)

Answer 17

Fatigue/lassitude
Weight loss
Anaemia

Question 18

RA: Clinical (Systemic features) specific (4) - organs

Answer 18

Eyes, Lungs, Nerves, Skin, Kidneys

Question 19

RA: Clinical (Systemic) - long term

Answer 19

CVS, malignancy

Question 20

When do nodules occur

Answer 20

relatively small % of patients

-

Question 21

Severe forms of systemic involvement

Answer 21

uncommonly seen

• vascualtic appearance - skin ulceration
• eye specific

Question 22

Assessment - disease activity?

what are the scores?

Answer 22

DAS<2.4 represents clinical remission

DAS>5.1 represents eligibility for biologic therapy