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Hugh's MD2 Core Conditions and Presentations > RA > Flashcards

Flashcards in RA Deck (25):
1

What is the limitation of the new biologic drugs?

The immune system adapts to circumvent the suppression

2

What is ACR20?

Clinical (patient and physician opinion) and radiological evaluation of treatment efficacy for a overall 20% improvement

3

What are some radiological signs that can be found in RA?

Periarticular erosions

Osteopenia

Ulnar subluxations at MCP joints

Fluffy erosions at MCP and PIP

Soft tissue swelling

4

How does RA synovitis feel on palpation?

Boggy

5

What is the combination therapy for RA?

Methotrexate

Hydroxylchloroquine

Sulphasalazine

6

What is reactive arthritis?

Immune complex mediated arthritis and myalgia post acute infection

7

What are the biological DMARDs?

TNF inhibitors - etanercept, infliximab

B cell inhibitor - rituximab

Cell adhesion inhibitor - abatacept

IL-6 inhibitor -Tocilizumab

8

What is the epidemiology of RA?

More common in women

 

9

What are some DDx for pain and stiffness in small joints of the hands?

RA

Reactive arthritis

Lupus

10

How are corticosteroids administered in RA?

Oral

Intra-articular

11

What is the name of the palpation finding in RA?

Synovitis

12

What is the best imaging to assess damage caused by inflammatory arthritis?

MRI

13

What are the DMARDs?

Hydrochloroquine

Sulphasalazine

Methotrexate

Leflunomide

14

How in RA treated pharmacologically?

Analgesic

Anti-inflammatory drugs 

Disease modifying anti-rheumatic drugs

15

Which clinical feature can reflect the severity of a patient's RA?

The duration of morning stiffness

16

What does lupus differ from RA on examination?

Synovitis is rarely present in lupus where it's a feature of RA

Arthralgia is more common in lupus

17

How has the methods of RA treatment changed?

Start with combination (methotrexate, sulphasalazine, hydroxychloroquine)

Then wean to maintenance therapy

18

Outline the ACR 1987 classification criteria for RA diagnosis

Patients must have 4 out of these 7

1. Morning stiffness >1 hour

2. Swelling in joints of the hand

3. Swelling in 3 or more joints

4. Symmetrical joint swelling

5. Erosions or calcifications on Xray

6. Positive rheumatoid factor

7. Rheumatoid nodules

 

19

How does the timecourse differ in inflammatory arthritis and mechanical arthritis?

Mechanical arthritis takes much longer and develops insipidusly over months

20

How do you Ix for inflammatory arthritis?

Rheumatoid factor, anti-Citrullinated Protein ab, anti-ANA ab

CRP, ESR

FBE - ?anaemia

MRI

21

How does RA present?

Arthritis of the small joints of the hand and feet

Deformity - valgus knee

Systemic signs - Fever, malaise, weight loss

22

What is naproxen?

An NSAID commonly used in arthritis'

23

How does methotrexate compare to the biologics in treating RA?

Not much different

24

What is the greatest environmental risk factor for RA?

Smoking

25

What is the pathophysiology of RA?

Autoimmune destruction of the synovial membrane and ongoing inflammation