Flashcards in Clinical (Weeks 1+2) Deck (183)
Loading flashcards...
1
What genes are associated with a susceptibility to RA?
HLA DR4
HLA DR1
2
What cells invade the synovium in RA?
Macrophages
Fibroblasts
Multinucleated giant cells
3
What is the basic process behind RA?
1. Synovial expansion
2. Invasion of bone
3. Erodes bone and cartilage
4
Articular symptoms of RA?
Joint pain
Morning stiffness
Joint swelling
5
Extra-articular manifestations of RA
Respiratory:
- Effusions
- Fibrosis
- Nodules
Rheumatoid nodules on extensor surfaces
Ocular involvement:
- Keratoconjunctivitis
- Episcleritis
- Uveitis
- Nodular scleritis
Increased CVS morbidity and mortality
6
What hand joint is not affected by RA?
DIP
7
What pattern of joint involvement is seen in RA?
Symmetrical
8
How is RA defined by the EULAR/ACR Classification?
Synovitis in >/=1 joint
Absence of better diagnosis
Achievement of >/=6/10 of:
- Number and site of affected joints (0-5)
- Serological abnormality (0-3)
- Increased CRP/ESR (0-1)
- Symptom duration (0-1)
9
What is the best autoantibody to test for to aid in the diagnosis of RA?
Anti-CCP (Cycli citrullinated peptide) Antibody
10
Does a patient need to be Rheumatoid Factor positive (RhF) to have RA?
No
11
What chronic haematological change may be seen in RA?
Anaemia
12
What x-ray changes are seen in RA?
Osteopaenia:
- Loss of joint space
- Periarticular erosions
Soft tissue swelling
13
What late complications can be seen in RA?
Infection
Cervical myelopahy secondary to:
- Atlanto-axial/Subaxial subluxation
ILD
Peripheral neuropathy
14
What comorbidities is RA associated with?
Severe infections
CVS mortality
Lymphoma
15
What genetic factor is a poor prognostic factor in RA?
HLA DR4 positive
16
How soon must treatment be begun in RA to prevent irreversible damage?
Within 3 months
17
What are the principles of RA treatment?
DMARDs
Steroids to cover lag phase
Frequent reviews
18
Give examples of DMARDs and when they might be used?
1st line - Methotrexate
2nd line and in pregnancy - Sulphasalazine
Hydroxychloroquine
Leflunamide
19
What four approaches to biologic therapy can be used in RA and give examples of drugs in each class?
TNF-alpha inhibition:
- Infliximab
- Adalimumab
- Etanercept
B cell depletion:
- Rituximab
Disruption of T cell co-stimulation:
- Abatecept
Interleukin inhibition:
- Anankira (IL-1)
- Tocilizumab (IL-6)
(Jak-2 inhibitors)
20
What is the pathogenesis of OA?
Loss of matrix (Collagen ii with chondrocytes embedded)
Cytokine release:
- IL-1
- TNF-alpha
- Metalloproteinases
- Prostaglandins from chondrocytes
Surface fibrosis and attempted repair -> Oestophytes
21
How are localised and generalised idiopathic OA defined
Localised:
- Hands
- Feet
- Knee
- Hip
- Spine
Generalised is >/= 3 sites involved
22
What are some secondary causes of OA?
Previous injury
RA
Genetic
Acromegaly
Crystal arthropathy
Perthes
SUFE
23
Risk factors of OA
Age
Female
Obesity
Job
Injury/Sports
24
When is pain typically present in OA?
During exercise
25
How long does morning stiffness last in OA?
Less than 30 minutes
26
What might be found on examination of a patient with OA?
Crepitus
Bony enlargements
Joint tenderness and effusion
27
What can lumbar spine OA result in?
Spinal stenosis
28
Where does hip OA pain radiate to?
Groin/back
29
OA at what site can result in genu valgum and a Baker's cyst?
Knee
30
