Rheumatoid Arthritis Flashcards
When is rheumatoid arthritis more common?
*women
*increases with age- peak 30-50 years
What is the pathophysiology of RA?
Disease of synovium- formation of new blood vessels- synovial proliferation (thickening) - invades joints- joint destruction
What is the clinical presentation of RA?
*usual signs of inflammation
*pain on movement initially
*then pain on rest- early morning stiffness
*flare up- stiff all day
What are the non articular presentations of RA?
*vasculotis- destroys blood vessels
*anemia- b12/ folic acid deficiency
*rheumatoid nodules
*dry gritty eyes
What is the ACR criteria?
Point system of: >6 = definite RA
*joint distribution- how many
*presence of RF rheumatoid factor or ACPA antibody
*duration of symptoms
*Normal or abnormal C reactive protein (RA> 10mg/L) and ESR (Ra>50mm/hr)
When should you refer urgently?
-small joints of hands or feet effected
-more than one joint
-had symptoms >3 months
What are the two classes of treatment options for RA?
*Oral NSAID’s
*csDMARD’s
further
*glucocorticosteoroids
*tsDMARD’s
*bDMARD’s
What advice is given to RA patients given NSAID’s?
Take late pm/early am for morning stiffness
Why are glucocorticoids used in RA?
Bridge between starting csDMARDS and feeling effect
What glucocorticoid and dose is used in RA?
Prednisolone 15mg daily
What are csDMARDs?
Conventional synthetic disease modifying anti rheumatic drugs
What are examples of csDMARDS?
Methotrexate
Leflunomide
Sulfasalazine
Hydroxychloroquine
What drug needs to be taken with methotrexate?
Folic acid 5mg 48 hours after methotrexate
What do csDMARDS do?
Lower ESR- control disease progression
What needs implemented if one csDMARD doesn’t work?
Step up strategy- introduce another csDMARD
