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rheumatoid arthritis Flashcards

(50 cards)

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1
Q

what type of arthritis is rheumatoid arthritis ?

A

inflammatory arthritis

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2
Q

which genes have been associated with an increased risk of rheumatoid arthritis?

A

HLA halotypes DR4 and DR1 , patients without the genes cannot get rheumatoid arthritis

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3
Q

what is pannus ?

A

synovial membrane infiltration

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4
Q

which cells produce the RF ?

A

b cells

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5
Q

what is the clinical picture of RA?

A
  • mainly the affection of the small joints of the hand except the DIP
  • symmetrical arthropathy
  • effusion, pain and affection of the hand function
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6
Q

what is the arrangement of the cells in pannus formation ?

A

t-cells and b-cells are in the centre and plasma cells and macrophages in the periphery

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7
Q

what is the most common pattern of presentation in RA?

A

insidious onset affecting the small joints of the hand and feet progressing to the elbows, shoulders and knees

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8
Q

what is the presentation like in 20% of RA cases ?

A

abrupt acute polyarthritis

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9
Q

what is palindromic rheumatism ?

A

variable episodes of polyarthritis ( comes and goes continuously and reaches a point where it doesn’t go anymore)

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10
Q

what are the hand deformities that can be found ?

A

ulnar deviation of the MCP
radial deviation of wrists
boutonniere deformity of fingers
swan-neck deformity of fingers
z-deformity of thumb

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11
Q

what are the characteristics of swan-neck deformity ?

A

PIP joint: hyperextension

DIP joint: flexion

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12
Q

what are the characteristics of boutonniere deformity ?

A

PIP joint: flexion

DIP joint : hyperextension

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13
Q

what is specific about the morning stiffness associated with RA?

A

lasts for more than one hour and usually decreases with movement

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14
Q

what are the extra articular manifestations found in the skin ?

A

formation of nodules which develop at sites of pressure

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15
Q

what are the extra articular features found in the eye ?

A

keratoconjunctivitis sicca ( sjogren’s syndrome )
scleritis
scleromalacia perforans

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16
Q

what are the pulmonary affections associated with RA?

A

pulmonary nodules
pulmonary fibrosis
Caplan’s syndrome

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17
Q

what is the most common cardiac manifestation in RA?

A

pericarditis

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18
Q

what are the renal manifestations associated with RA?

A

renal amyloid

GN ( related to drugs)

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19
Q

what are the neurological complications associated with RA?

A

cervical cord compression (atlanto-axial)
entrapment neuropathies
peripheral neuropathy
mononeuritis multiplex

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20
Q

what is the presentation of mononeurtitis multiplex ?

A

nerve of the foot is affected causing a drop foot

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21
Q

what are the associated haematological manifestations ?

Study These Flashcards
A

normochromic normocytic anemia
thrombocytosis

22
Q

what is felty’s syndrome ?

Study These Flashcards
A

it is an extra-articcular manifestation of serop-positive rheumatoid

SANTA
splenomegaly
anemia
neutropenia
thrombocytopenia
arthritis

23
Q

what investigations would you order if you’re suspecting RA?

Study These Flashcards
A 
CBC 
ESR, CRP 
urea and creatininne, LFTs 
RF
Anti-CCP
24
Q

which Ab is more specific to look for in serology in RA?

25
what is rheumatoid factor ?
made by B-cells and are IgM against the Fcp portion of IgG
26
when is the titre of rheumatoid factor high ?
if the patient has : extra-articular manifestation nodules in severe disease
27
can healthy people be positive for RF ?
yes
28
what difference inn prognosis is there inn seronegative and seropositive patients ?
seropositive patients have a worse prognosis
29
what non-lab investigations would be required ?
x-rays | joint aspiration
30
how is a diagnosis of RA made ?
presence of RF CRP and ESR are usually raised DAS28 is usually raised
31
what are the criteria in the ACR classification of RA ?
``` morning stiffness lasting at least 1 hour swelling in 3 or more joints swelling in hand joints symmetric joint swelling erosion or decalcification on X-ray rheumatoid nodules abnormal serum RF ```
32
what is the time period required to make a diagnosis of RA ?
at least 6 weeks
33
how many of the ACR criteria are required to make a diagnosis of RA ?
4 out of 7
34
with the updated classification of RA what is the number of criteria required to make a diagnosis ?
6/10 to overcome the problem of 6 weeks
35
what are the X-ray findings associated with rheumatoid arthritis ?
soft tissue swelling periarticular osteopenia narrowing of joint space subluxations and deformities
36
what is the main line of treatment of RA ?
DMARDs along with NSAIDs
37
what are the important contraindications associated with NSAIDs ?
PUD renal impairment Asthma
38
what are the different DMARDs ?
methotrexate hydroxychloroquine and chloroquine salazopyrin leflunomide penicillamine
39
what are the side effects of methotrexate ?
hepatotoxic bone marrow suppression so monitor liver function and CBC carefully
40
what are the side effects of hydroxychloroquine ?
skin pigmentation retinopathy myopathy
41
what are the side effects of salazopyrine ?
rashes liver abnormalities
42
what are the side effects of leflunomide ?
diarrhoea, alopecia, rash and abnormal liver function tests
43
what immunosuppressants can be used ?
azathioprine cyclophosphamide cyclosporine
44
what are the side effects of each type of immunosuppressant ?
AZA - BM suppression , malignancy Cyclophosphamide - myelosuppression, gonadal toxicity, hemorrhagic cystitis cyclosporine - hypertension and creatinine rise
45
what are the biologic drugs for RA ?
etanercept infliximab
46
what must infliximab be given with ?
methotrexate
47
what is the first line treatment for adults newly diagnosed with RA ?
methotrexate consider hydroxychloroquine for palindromic disease
48
what is the best treatment to control flaer ups of RA in pregnant women ?
hydroxychloroquine sulfasalazine along with folate supplementation
49
which DMARDs should be avoidd in pregnancy ?
leflunomide methotrexate
50
before the initiation of biologic treatment what must be screened for first ?
mycobacterium TB

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