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Phase 4 Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is Rheumatoid arthritis and its epidemiology

A

Chronic inflammatory autoimmune disease. It has a gradual onset over days to weeks. More common in females and smokers. The peak onset of 40-60.

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2
Q

What are the articular features of rheumatoid arthritis

A
  • Symmetrical polyarticular inflammaotry arthritis involving the small joints of hands, weists and feet. Other joints affected as disease porgresses
  • Inflammatory pain which is better with movement and associated with EMS > 30mins
  • Distal interphalangeal joints spared (different from psoriatic arthritis)
  • Joints are warm, tender and swollen
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3
Q

What are the specific articular deformities in Rheumatoid arthritis?

A
  • Wrist subluxation,
  • MCP subluxation
  • Swan neck finger deformity (MCP felxtion, PIP hyperextension and DIP hyperflexion)
  • Boutonniere finger deformity (PIP hyperflexion and DIP hyperextension)
  • Ulnar deviation of proximal phalanges
  • Z-shaped thumb.
  • Feet deformities (hammer toes)
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4
Q

What is the presentation of C-spine involvement in rheumatoid arthritis?

A
  • RA typically spares lumbar and thoracic spine.
  • Neck pain readiating to the occiput but can also cause myelopathy resulting in weakness in upper limbs
  • Minor neck trauma can therefore cause serious complications such as migration of the odentoid peg through the foramen magnum so do C-spine imaging
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5
Q

What are the peri-articular features in Rheumatoid arthritis?

A
  • Carpal tunnel syndrome (pain, weakness and paraesthesia in median nerve distribution)
  • Tenosynovitis (usually of flexor tendons of the hand)
  • Bursitis (typically of olecranon and sub-acromial)
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6
Q

What are the general systemic features of Rheumatoid arthritis?

A

RA is a multisystem inflammatory disease which can affect most organs.
Patients feel generaly unwell with fevers, weight loss and fatigue.

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7
Q

What are the haematological fatures of rheumatoid arthritis

A
  • Anaemia of chronic disease (common)
  • Splenomegaly
  • Amyloidosis
  • Generalised lymphadenopathy
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8
Q

What is Felty’s syndrome?

A

Triad of Rheumatoid arthritis, splenomegaly and neutropenia

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9
Q

What are the dermatological features of Rheumatoid arthitis?

A
  • Rhumatoid nodules (firm, dark nodules usually around inflammation)
  • Small vessel vasculitis
  • Raynauds syndrome
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10
Q

What are the ophthalmic features of Rheumatoid arthritis?

A
  • Keratoconjunctivitis sicca (dry eyes)
  • Episcleritis and scleritis
  • Steroid induced cataracts
  • Chloroquine retinopathy
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11
Q

What are the respiratory features of Rheumatoid features?

A
  • Pleural effusions containing rheumatoid factor
  • Pulmonary rheumatoid nodules
  • Pneumonitis leading to pulmonary fibrosis (can be due to methotrexate)
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12
Q

What are the orthopaedic features of Rheumatoid arthritis?

A

Osteoporosis

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13
Q

What are the cardiac factures of rheumatoid arthritis?

A
  • IHD (RA has similar risks to T2DM)
  • Pericardial effusions containing rheumatoid factor
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14
Q

What are the neurological features of rheumatoid arthritis?

A

Peripheral neuropathy

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15
Q

What are the antibodies seen in Rheumatoid arthritis?

A

Rheumatod factor (IgM antibody which feacts with the Fc region of patients own IgG. Type III hypersensitivity) - first line
Anti-CCP is more specific than RF

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16
Q

What are the radiological features of Rheumaotid arthritis?

A
  • Soft tissue swelling
  • Periarticular osteoporosis,
  • Juxta-articular erosion
  • Narrowing of joint space
    SPADES: Soft tissue swelling, periarticular osteoporosis, abscent joint space, defromity, erosions, subluxation
17
Q

What is the socrring system used in rhumatoid arthritis?

A

DAs28

18
Q

What is the treatment for symptomatic relief in RA?

A
  • Regular paracetamol and NSAIDs,
  • During flares - intra-articular or oral course of steroids
19
Q

What is the indication for DMARD treatment in RA?

A

If DAS28 score is over 5.1?? or as soon as possible

20
Q

What are the reccomended DMARDs for RA and when should they be started?

A

Start within three months - Methotrexate, sulfasalazine or leflunomide

21
Q

What biologic drugs can be used in RA and when?

A

TNF alpha agents eg, infliximab.
Offered when DAS28>5.1 despite long-term DMARD therapy

22
Q

What DMARD drugs can be used in pregnancy?

A

Hydroxychloroquine or sulfasalazine

23
Q

What are poor prognostic features of rheumatoid arthritis?

A
  • Rheumatoid factor postitive
  • Anti-CCP antibodies
  • Early erosions on X rays
  • Extra-articular features
  • HLA DR4
24
Q

Explain the diagnosis of rheumatoid arthritis

A
  • Rheumatoid factor
  • Anti-CCP antibodies
  • X-rays of hands and feet

Phase 4 Rheumatology (16 decks)

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