Rheumatoid Arthritis

Question 1

What is rheumatoid Arthritis

Answer 1

Inflammatory autoimmune SYMMETRICAL poly arthritis

Question 2

What are the RF for RA

Answer 2

Women 30-50 (Premeno)
Smoking
HLADR4/DRB1

Question 3

What is the pathology of RA

Answer 3

Arginine to citruline mutation in T2 Collagen
Anti-CCP Formation
IFN-Alpha causes inflammation in Synovium
Synovial lining expands w/mass (Pannus)
Pannus destroys subchondral bone and articular cartillage

Question 4

What amino acid mutation occurs in RA

Answer 4

Arginine to Citruline @ T2 collagen

Question 5

What triggers IFN-Alpha to cause inflammation at Synovium

Answer 5

Anti-CCP Formation

Question 6

What are the Presentations of RA

Answer 6

>30Min morning pain better through day
HAND DEFORMITIES
-Boutonniere
-Swan neck
-Z Thumb
-Ulnar finger deviation
Symmetrical, Hot inflamed joints

Question 7

What are the 4 hand deformities found in RA

Answer 7

Boutonniers
Swan neck
Z Thumb
Ulnar finger deviation

Question 8

How do the joints present typically in all RA

Answer 8

Hot Inflamed and symmetrical

Question 9

In RA DIPJ is often spared, What differential is not DIPJ Sparing

Answer 9

Psoriatic Arthritis

Pencil in cup

Question 10

What syndrome is RA a part of which causes life threatening risk of infection

Answer 10

Felty’s Syndrome

• RA
• Granulocytopenia
• Splenomegaly

Question 11

What are the extra articular Sx of RA

Answer 11

PE and Pulmonary Fibrosis (Lungs)
IHD Risk (Heart)
Episcleritis /Keratoconjunctivitus sicca (Eyes)
CKD (Kidney)
Elbow nodules

Question 12

What is Keratoconjunctiitus Sicca

Answer 12

Dry eyes

Question 13

How is RA investigated

Answer 13

Bloods = Raised ESR/CRP w/ Normochromic/cytic anaemia
Serology. =Anti CCP and RF
X ray = LESS

Question 14

What does the Xray show for RA (LESS)

Answer 14

Loss of joint space
Eroded bone
Soft tissue swelling
Soft bones (Osteopenia)

Question 15

What blood markers are used to monitor RA progression

Answer 15

ESR and CRP

Question 16

How is RA treated

Answer 16

DMARD = Methotrexate
NSAID = Analgesia
Steroid injection
Biologics (Infliximba/Rituximab)

Question 17

What is the Gold standard treatment for RA

Answer 17

Methotrexate w/ Infliximab

Question 18

What is the difference between Infliximab and Rituximab

Answer 18

Infliximab = TNF-Alpha blocker
Rituximba = B cell inhibitor as CD20 target

Question 19

What is the problem of methotrexate chronic use in RA

Answer 19

Inhibits folate so can cause Macrocytic anaemia

Question 20

What are the genetic associations w/ RA

Answer 20

HLA DR4/DRB1

HLA DRB1

Question 21

What is Felty’s syndrome

Answer 21

Triad of symptoms w/
Rheumatoid arthritis
Splenomegaly
Granulocytopenia

Question 22

What is the list of investigations used in RA

Answer 22

Bloods
Anti CCP and RF
X Ray = LESS

Question 23

What is the first line management of RA

Answer 23

Methotrexate and Infliximab

Question 24

Why is Methotrexate contraindicated in Pregnancy

Answer 24

Inhibits Folate by inhibiting DNA synthesis

Question 25

What type of drug is methotrexate

Answer 25

DMARD

Question 26

What type of drug is Infliximab

Answer 26

Anti TNF Alpha inhibitor

Question 27

What type of drug is rituximab

Answer 27

CD20 B cell inhibitor

Question 28

What are the two eye features of RA

Answer 28

Episcleiritis
Keratojunctivitis Sicca

Question 29

How is pain different in RA vs Osteoarthritis

Answer 29

Pain is better with use

Question 30

What is A Baker’s cyst in RA

Answer 30

Popliteal sac buldge

Question 31

What can be administered to support as an analgesic in RA

Answer 31

NSAID

Question 32

What type of anaemia is commonly found in RA

Answer 32

Normocytic Normochromic of Chronic

Question 33

What are the two main joints affected in RA

Answer 33

MCP and PIPJ