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Rheumatoid Arthritis Flashcards

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1
Q

What is the main stucture involved in Rheumatoid Arthritis?

A

The synovium

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2
Q

What is defined as Early Rheumatoid Arthritis?

A

Within 2 years of symptom onset

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3
Q

What are the classical clincial features of Rheumatoid Arthritis?

A

Prolonged Morning stiffness

Involvement of small joints of the hands and feet

Symmetical distribuion

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4
Q

What are the two key auto antibodies in Rheumatoid Arthritis?

A

Rheumatoid Factor

Anti-CCP

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5
Q

Why is Anti-CCP more useful than Rheumatoid factor?

A

Anti-CCP is 90-99% specific

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6
Q

What is important to know about Anti - CCP?

A

Can be present before disease

Co-relates with disease activity

Absence does not exclude disease

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7
Q

What are the Cut offs for the DAS28 scoring system?

A

< 2.6 remission

  1. 6-3.2 Low disease
  2. 2- 5.1 Moderate disease

>5.1 Active disease

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8
Q

What is the main stay treatment for Inflammatory Arhropathies

A

Analgesia

Steroids
Disease modifiying anti rheumatic drugs

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9
Q

What does Seropositive and Seronegative mean?

A

Seropositive means there are auto-antibodies in the blood

Seronegative means that there are no auto-antibodies in the blood

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10
Q
A
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11
Q

What are the categories of Arthrities?

A

Non- inflammatory

Inflammatory - seropostitive and seronegative

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12
Q

What does seropositive mean?

A

Auto-antibodies in serum

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13
Q

What is the most common form of arthritis?

A

Osteoarthritis

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14
Q

What factors contribute to your risk of Osteoarthritis?

A

Hobbies

Abnormal Joint alignmeant

Previous injuries

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15
Q

What are the typical radiograph findings of a osteoarthritic joint?

A

Loss of joint space

Osteophytes

Sclerosis

Subchondral cysts

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16
Q

What is Sclerosis ?

A

Hardening of bone

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17
Q

What is the usual management of oseteoarthritis?

A

Pain relief

simple analgesia and opiates

Surgery if appropriate

Physiotherapy and weight loss

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18
Q

What are the four groups of inflammatory arthropathies?

A

Seropositive

Seronegative

Infectious

Crystal deposition disorders

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19
Q

What are some classical feauters of Inflammatory Arthritis?

A

Joint pain and swelling

Morning stiffness which eases off with movement

Synovitis

Raised inflammatory markers

Extra-articular symptoms

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20
Q

What is the pathogenesis of rheumatoid arthritis?

A

Auto-immune response initiated against synovium

An infllammatory panus forms which then attacks the articular cartilage leading to joint destruction

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21
Q

How is a diagnosis of Rheumatoid Arthritis made?

A

combination of :

Clinical presentation

radiograph findings

serological analysis

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22
Q

What joints in the hand are affected by rheumatiod arthritis?

A

Wrist joint

MCP and PIP

NOT DIP (no synovium)

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23
Q

What can long standing cervial rheumatoid arthritis cause?

A

Atlanto-axial subluxation resulting in cervical cord compression

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24
Q

What are Rheumatoid Nodules?

A

They occour in 25% of people with rheumatoid arthritis

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25
What are the two Auto-antibodies measured in rheumatoid arthritis?
Rheumatoid Factor and Anti-CCP
26
Which auto-antibody is more specific in rheumatoid arthritis?
Anti CCP
27
What perecentage of people with rheumatoid arthritis are Sero-negative?
20%
28
Other than auto-antibodies, what else might you find in blood tests?
CRP, ESR and Plasma Viscosity is raised.
29
What is ESR?
Erythromyte sedementation rate
30
What is the goal in treating rheumatoid arthritis?
Relieve symptoms Slow down disease progression
31
What is the "golden window" with regards to rheumatoid arthritis?
DMARDs should be started within 3 months of the onsent of symptoms
32
What is the first line DMARD for rheumatoid Arthritis?
Methotrexate
33
Name four DMARDs for use in rheumatoid Arthritis?
Methotrexate Sulphasalazine Hydroxycholroquine Leflunomide
34
What must you be aware about when prescribing DMARDs?
They can cause bone marrow suppression and immune supression Regular blood monitoring is a must
35
What can you use in Rheumatoid arthritis if DMARDs arent working?
Biologics injection anti-TNF alpha drugs
36
Name 3 biologics used in rheumatoid Arthritis
Toclizumab Ritximab Abatacept
37
What must you be aware of when using biologics in rheumatoid arthritis?
They cause and inceased risk of infection; especially to TB
38
What are the cut offs in the DAS 28 score?
\< 2.6 : remission 2. 7 - 3.1 : low disease activity 3. 1 - 5.1 : moderate disease activity \> 5.1 : high disease activity
39
What must the DAS 28 score be in order to be eligible for biologic therapy?
High disease activity \>5.1
40
What alternative therapies can be usueful in rheumatoid arthritis?
allied health professionals Synovectom Joint replacement Joint excision Arthrodesis Cevical spine stabilisation
41
What are the categories of Arthrities?
Non- inflammatory Inflammatory - seropostitive and seronegative
42
What does seropositive mean?
Auto-antibodies in serum
43
What is the most common form of arthritis?
Osteoarthritis
44
What factors contribute to your risk of Osteoarthritis?
Hobbies Abnormal Joint alignmeant Previous injuries
45
What are the typical radiograph findings of a osteoarthritic joint?
Loss of joint space Osteophytes Sclerosis Subchondral cysts
46
What is Sclerosis ?
Hardening of bone
47
What is the usual management of oseteoarthritis?
Pain relief simple analgesia and opiates Surgery if appropriate Physiotherapy and weight loss
48
What are the four groups of inflammatory arthropathies?
Seropositive Seronegative Infectious Crystal deposition disorders
49
What are some classical feauters of Inflammatory Arthritis?
Joint pain and swelling Morning stiffness which eases off with movement Synovitis Raised inflammatory markers Extra-articular symptoms
50
What is the pathogenesis of rheumatoid arthritis?
Auto-immune response initiated against synovium An infllammatory panus forms which then attacks the articular cartilage leading to joint destruction
51
How is a diagnosis of Rheumatoid Arthritis made?
combination of : Clinical presentation radiograph findings serological analysis
52
What joints in the hand are affected by rheumatiod arthritis?
Wrist joint MCP and PIP NOT DIP (no synovium)
53
What can long standing cervial rheumatoid arthritis cause?
Atlanto-axial subluxation resulting in cervical cord compression
54
What are Rheumatoid Nodules?
They occour in 25% of people with rheumatoid arthritis
55
What are the two Auto-antibodies measured in rheumatoid arthritis?
Rheumatoid Factor and Anti-CCP
56
Which auto-antibody is more specific in rheumatoid arthritis?
Anti CCP
57
What perecentage of people with rheumatoid arthritis are Sero-negative?
20%
58
Other than auto-antibodies, what else might you find in blood tests?
CRP, ESR and Plasma Viscosity is raised.
59
What is ESR?
Erythromyte sedementation rate
60
What is the goal in treating rheumatoid arthritis?
Relieve symptoms Slow down disease progression
61
What is the "golden window" with regards to rheumatoid arthritis?
DMARDs should be started within 3 months of the onsent of symptoms
62
What is the first line DMARD for rheumatoid Arthritis?
Methotrexate
63
Name four DMARDs for use in rheumatoid Arthritis?
Methotrexate Sulphasalazine Hydroxycholroquine Leflunomide
64
What must you be aware about when prescribing DMARDs?
They can cause bone marrow suppression and immune supression Regular blood monitoring is a must
65
What can you use in Rheumatoid arthritis if DMARDs arent working?
Biologics injection anti-TNF alpha drugs
66
Name 3 biologics used in rheumatoid Arthritis
Toclizumab Ritximab Abatacept
67
What must you be aware of when using biologics in rheumatoid arthritis?
They cause and inceased risk of infection; especially to TB
68
What are the cut offs in the DAS 28 score?
\< 2.6 : remission 2. 7 - 3.1 : low disease activity 3. 1 - 5.1 : moderate disease activity \> 5.1 : high disease activity
69
What must the DAS 28 score be in order to be eligible for biologic therapy?
High disease activity \>5.1
70
What alternative therapies can be usueful in rheumatoid arthritis?
allied health professionals Synovectom Joint replacement Joint excision Arthrodesis Cevical spine stabilisation

MSK- Rheumatology (8 decks)

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