Rheumatoid Arthritis Flashcards
(31 cards)
What is rheumatoid arthritis?
An autoimmune condition that causes chronic inflammation in the synovial lining of the joints, tendon sheaths, and bursa.
What type of arthritis is rheumatoid arthritis classified as?
Inflammatory arthritis.
What is synovial inflammation called?
Synovitis.
What pattern does rheumatoid arthritis typically follow in joint involvement?
Symmetrical polyarthritis.
List some risk factors for rheumatoid arthritis.
- Female
- Middle aged
- Smoking
- Obesity
- Family history
- HLA DR4 gene
What is rheumatoid factor?
An autoantibody present in 70% of RA cases that causes immune system activation against IgG.
What are anti-cyclic citrullinated peptide antibodies?
Antibodies that are positive in 80% of RA cases and often predate condition presentation.
What are common joint symptoms of rheumatoid arthritis?
- Worse with rest, improves with activity
- Worse in the morning
- Pain
- Stiffness
- Swelling
What joints are typically affected in symmetrical distal polyarthritis?
- MCP joints
- PIP joints
- Wrist
- MTP joints (foot)
What are some palpation findings in rheumatoid arthritis?
- Tenderness
- Synovial thickening
- ‘Boggy’ feeling
What systemic symptoms may accompany rheumatoid arthritis?
- Fatigue
- Weight loss
- Flu-like illness
- Muscle aches and weakness
What is palindromic rheumatism?
Self-limiting episodes of inflammatory arthritis, with pain, stiffness, and swelling affecting only a few joints.
What are the hand signs in advanced rheumatoid arthritis?
- Z-shaped thumb deformity
- Swan neck deformity
- Boutonniere deformity
- Ulnar deviation of fingers at MCP joints
What is atlantoaxial subluxation?
A condition occurring in the cervical spine due to synovitis and ligament damage around the axis (C2) leading to a shift in the atlas (C1).
What are some extra-articular manifestations of rheumatoid arthritis?
- Pulmonary fibrosis
- Felty’s syndrome
- Sjogren’s syndrome
- Anaemia of chronic disease
- Cardiovascular disease
- Eye manifestations (dry eye syndrome, episcleritis, scleritis, keratitis)
- Rheumatoid nodules
- Carpal tunnel syndrome
What should be done for diagnosis when there is persistent synovitis?
Urgent referral for assessment.
What initial assessments are recommended for diagnosing rheumatoid arthritis?
- Rheumatoid factor
- Anti-CCP antibodies
- Inflammatory markers (CRP, ESR)
- X-rays
- Ultrasound or MRI
What x-ray changes are indicative of rheumatoid arthritis?
- Periarticular osteopenia
- Boney erosions
- Soft-tissue swelling
- Joint destruction and deformity
What scoring systems are used in rheumatoid arthritis?
- Health Assessment Questionnaire (HAQ)
- Disease Activity Score 28 Joints (DAS28)
What is the aim of management in rheumatoid arthritis?
To induce remission using CRP and DAS28 to monitor success of treatments.
What initial treatment is recommended for rheumatoid arthritis?
Short-term steroids.
What is the first-line DMARD therapy for rheumatoid arthritis?
Methotrexate.
What are the side effects of methotrexate?
- Mouth ulcers, mucositis
- Liver toxicity
- Bone marrow suppression
- Teratogenic
What are some other DMARDs used in rheumatoid arthritis?
- Felunomide
- Sulfasalazine
