Rheumatoid arthritis Flashcards by Zoe Doak

Q

Respiratory manifaestations of RA

A

pulmonary fibrosis
pleural effusion
pulmonary nodules
bronchiolitis obliterans methotrexate pneumonitis
pleurisy

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Q

Ocular manifestations of RA

A

keratoconjunctivitis sicca (most common)
episcleritis/ scleritis
corneal ulceration
keratitis
steroid-induced cataracts
chloroquine retinopathy

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Q

Complications associated with RA

A

osteoporosis
ischaemic heart disease
risk of infections
depression

Less common:
Felty’s syndrome (RA + splenomegaly + low white cell count)
amyloidosis

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Q

RA + splenomegaly + low white cell count

A

Felty’s syndrome

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Q

Criteria which increase likelihood of RA diagnosis

A

Multiple joints affected
positive anti-RF and anti-CCP
high inflammatory markers
Symptoms persisting >6 weeks

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Q

Which drug has the following side effects?

Myelosuppression
Liver cirrhosis
Pneumonitis

A

Methotrexate

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Q

Which drug has the following side effects?

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

A

Sulfasalazine

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Q

Which drug has the following side effects?

Liver impairment
Interstitial lung disease
Hypertension

A

Leflunomide

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Q

Which drug has the following side effects?

Retinopathy
Corneal deposits

A

Hydroxychloroquine

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Q

Which drug has the following side effects?

Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts

A

Steroids

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Q

Which drug has the following side effects?

Proteinuria

A

Gold

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Q

Which drug has the following side effects?

Proteinuria
Exacerbation of myasthenia gravis

A

Pencillamine

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Q

Which drug has the following side effects?

Demyelination
Reactivation of tuberculosis

A

Etanercept

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Q

Which drug has the following side effects?

Reactivation of tuberculosis

A

Infliximab/ Adalimumab

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Q

Which drug has the following side effects?

Infusion reactions are common

A

Rituximab

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Q

Which drug has the following side effects?

Bronchospasm in asthmatics
Dyspepsia/peptic ulceration

Study These Flashcards

A

NSAIDs

Q

Tests used to detect Rheumatoid factor (RF)

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A

Rose-Waaler test: sheep red cell agglutination
Latex agglutination test

Q

What percentage of patients with RA are positive for RF

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A

70-80%

Q

RF is considered a marker of RA disease activity. TRUE/FALSE?

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A

FALSE

Q

Other conditions in which RF is positive

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A

Felty’s syndrome
Sjogren’s syndrome
infective endocarditis
SLE
systemic sclerosis
general population ~5%
rarely: TB, HBV, EBV, leprosy

Q

Sensitivity and specificity of Anti-CCP

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A

Sensitivity ~ 70%
Specificity ~ 90-95%.

Q

initial treatment for RA

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A

NICE recommend DMARD monotherapy +/- a short-course of bridging prednisolone

Q

Options for DMARD therapy

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A

Methotrexate
sulfasalazine
leflunomide
hydroxychloroquine

Q

Why must patients have FBC and LFTs monitored on Methotrexate?

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A

due to the risk of myelosuppression and liver cirrhosis.

How do we monitor response to DMARD treatment?

combination of CRP and disease activity score (DAS28 score)

management of RA flare

corticosteroids - oral or intramuscular

Indication for TNF inhibitor therapies

inadequate response to at least two DMARDs including methotrexate

options of TNF inhibitor therapies

etanercept infliximab adalimumab

Which anti-CD20 monoclonal antibody infusion can be used to treat RA?

Rituximab (B-cell depletion) 2x 1g intravenous infusions are given two weeks apart

What is Abatacept?

fusion protein that modulates a key signal required for activation of T lymphocytes leads to decreased T-cell proliferation and cytokine production (NOT YET APPROVED BY NICE)

RA symptoms tend to improve in pregnancy and flare following delivery. TRUE/FALSE?

TRUE - patients with early or poorly controlled RA should be advised to defer conception until their disease is more stable

What DMARDs are safe in pregnancy?

SAFE: = sulfasalazine and hydroxychloroquine UNSAFE = Methotrexate and leflunomide low-dose corticosteroids may be used in pregnancy to control symptoms

Clinical features

swollen, painful joints in hands and feet stiffness worse in the morning gradually gets worse with larger joints becoming involved insidiously onset positive 'squeeze test'

Describe the names given to RA bony deformities in the hands

Swan neck and boutonnière deformities

Poor prognostic features

rheumatoid factor positive anti-CCP antibodies poor functional status at presentation X-ray: early erosions (< 2 years) extra articular features HLA DR4 insidious onset

Early XR findings in RA

loss of joint space juxta-articular osteoporosis soft-tissue swelling periarticular erosions subluxation