RA

Question 1

presentation of RA

Answer 1

swollen, painful joints in hands and feet
stiffness worse in the morning
gradually worse with larger joints becoming involved
positive squeeze test
swan neck and boutonniere deformities late features

Question 2

antibodies in RA

Answer 2

RF (not a marker of disease activity)
anti-CCP

Question 3

investigations for RA

Answer 3

anti-CCP and x-ray

Question 4

x-ray changes in RA

Answer 4

loss of joint space
juxta-articular osteoporosis
soft tissue swelling
periarticular erosions
subluxation

Question 5

initial management of RA

Answer 5

DMARD
plus: analgesia, physio and surgery

initially: DMARD monotherapy +/- prednisolone to cover

Question 6

how to monitor response to treatment initially in RA

Answer 6

combination of CRP and disease activity

Question 7

how to manage flares of RA

Answer 7

corticosteroids- oral or IM

Question 8

what is the indicator for TNF-inhibitors

Answer 8

inadequate response to at least two DMARDs including methotrexate

try: etanercept, infliximab, adalimumab