Rheumatoid Arthritis Flashcards

1
Q

what type of inflammatory arthopathy is RA

A

seropositive

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2
Q

what joints are most commonly affected

A

small joints of hands and feet

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3
Q

when are larger joints affected

A

as disease progresses

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4
Q

are men or women more commonly affected

A

women (2-3 x’s)

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5
Q

what is the prevalence

A

1%

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6
Q

what is the peak age group

A

35-50

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7
Q

what percentage of risk factors do genetics contribute to

A

50%

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8
Q

how increased is a persons risk of developing RA if a first degree relative has it

A

2-3

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9
Q

what is the pathogenesis

A

immune response initiated against synovium lining synovial joint and some tendons,
inflammatory pannus forms which attacks and denudes articular cartilage leading to joint destruction,
tendon rupture and soft tissue damage can then occur

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10
Q

what are some potential triggers for initiating the immune response

A

smoking, infection or trauma

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11
Q

what does tendon rupture and soft tissue damage lead to

A

instability and subluxation

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12
Q

what is diagnosis based on

A

clinical presentation, radiographic findings and serological analysis

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13
Q

what criteria’s can aid diagnosis

A

ACR and EULAR

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14
Q

what are clinical features of RA

A
  • symmetrical synovitis (doughy swelling)
  • pain
  • morning stiffness
  • hands and feet in early stages
  • MCP and PIP’s affected but DIP’s not
  • wrists affected
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15
Q

what is a long term complication involving spine involvement

A

cervical spine

atlanto-axial subluxation resulting in cervical cord compression

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16
Q

what are some extra-articular manifestations

A

rheumatoid nodules, lung involvement, increased cardiovascular morbidity and mortality, ocular involvement

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17
Q

what percentage of patients tend to have rheumatoid nodules

A

25%

18
Q

where are rheumatoid nodules usually found

A

extensor surfaces or sites of frequent mechanical irritation

19
Q

what is usually present in lung involvement

A

pleural effusions, interstitial fibrosis and pulmonary nodules

20
Q

what is present in ocular involvement

A

keratoconjunctivitis sicca, episcleritis, uveitis and nodular scleritis that may lead to scleromalacia

21
Q

what are investigations

A

autoantibodies, CRP, ESR and plasma viscosity, X-ray

22
Q

what are the 2 autoantibodies associated with RA

A

rheumatoid factor and anti-ccp

23
Q

which autoantibody is more specific

A

anti-ccp

24
Q

what percentage of patients with RA are seronegative (no positive autoantibodies)

A

15-20%

25
Q

are X-rays a good test in early disease

A

no

often show no joint involvement

26
Q

what can X-rays show in early stages

A

peri-articular osteopenia (bone thinning) and soft tissue swelling

27
Q

what can X-rays show in later stages

A

periarticular erosions

28
Q

what can ultrasounds be useful for detecting

A

synovial inflammation if clinical uncertainty

29
Q

what is the target time period to have started DMARD’s by

A

3 months of symptom onset

30
Q

treatment

A

symptom relief (analgesia, NSAID’s and steroids)

31
Q

what is the first line DMARD

A

methotrexate

32
Q

what is a negative of DMARDS

A

can be immunosuppressive and suppress bone marrow so increase infection risk

33
Q

is blood monitoring required when using DMARD’s

A

yes

34
Q

what is the criteria to prescribe biologics

A

DAS 28 score of >5.1 (means high disease activity)

35
Q

what are the most common used biologics

A

anti-TNF alpha drugs

36
Q

how are anti-TNF alpha drugs administered

A

injection

37
Q

there is also an increased risk of infection with biologics, which in particular

A

TB

38
Q

what are other institutions for therapies for RA

A

physio, occupational therapy, podiatry, orthotists

39
Q

what is surgery used for

A

resistant disease to control pain from a particular joint or improve or maintain function

40
Q

operations for RA

A

synovectomy, joint replacement, joint excision, tendon transfers, arthrodesis (fusion), cervical spine stabilisation