Rheumatoid arthritis

Question 1

RA affects any joint with a ___

Answer 1

synovium

Question 2

F:M of RA

Answer 2

F3:1M

Question 3

HLA ___ mediates RA

potential triggers =//_

Answer 3

DR4

smoking, infection stress

Question 4

vertebral joint that has a synovium

Answer 4

C1/2

Question 5

joint in the hand that doesn’t have a synovium and therefore isnt affected by RA

Answer 5

DIPJ

Question 6

pannus =
=> __+__ erosion
in RA

Answer 6

macrophages and fibroblast-like mesenchymal cells, macrophages and mast cells etc
bone and cartilage

Question 7

pathogenesis of RA : APC > ___ > activate __ (produce ++_ > chondrocytes =>__) + ___ (produce + > chondrocytes => __) => inflam and erosion

Answer 7

T cells
Macrophages - TNFα, IL1+6 => MMPs
B cells - RF + IL6 => MMPs

Question 8

therapeutic window for best results in RA treatment

Answer 8

first 3 months

Question 9

RA criteria relies on these 4 things

Answer 9

joint distribution (number affected)
serology
duration (>6wk)
inflammatory markers

Question 10

Ix for diagnosis of RA

Answer 10

Hx + exam (clinical diagnosis)
bloods (anaemia and raised platelets)
inflam markers (CRP/ESR + PV)
autoIg
imaging

Question 11

RA can present with this ___

= hip and shoulder pain worse in morning

Answer 11

polymyalgia rheumatica

Question 12

if back of wrist swells in RA = ____ of ___

Answer 12

extensor tenosynovitis (extensor carpi ulnaris)

Question 13

autoIgs in RA:

most specific =

Answer 13

RF
anti CCP (cyclic citrullinated peptide) - most specific

Question 14

anti-CCP doesnt ___ after Rx of RA and so is just ___

Answer 14

decrease

diagnostic

Question 15

+ve anti CCP RA is more likely to be ____ and associated with ___

Answer 15

aggressive

erosion

Question 16

anti-CCP Ig is associated with ___ as it citrullinates peptides in the ___ and causes Ig production

Answer 16

smoking

lung

Question 17

baseline imaging for RA =

Answer 17

xray

Question 18

xray findings of late RA

Answer 18

soft tissue swelling
periarticular osteopenia
erosions

Question 19

imaging that has increased sensitivity for early synovitis and can catch subclinical inflammation in RA
In RA also used to make ___ changes

Answer 19

US

treatment changes

Question 20

imaging that can see bone marrow oedema, distinguish synovitis from effusions and monitor activity of RA =
only used if ___ as is __

Answer 20

MRI
other tests are ineffective
costly

Question 21

RA: DAS28 parameters =

used to __

Answer 21

number of tender and swollen joints (out of 28)
ESR+CRP
patients evaluation
monitoring activity of RA

Question 22

DAS28 score of __ means RA is aggressive

Answer 22

> 5.1

Question 23

DAS28 score of __ means RA is in remission

Answer 23

<2.6

Question 24

treatment of RA broadly speaking =

Answer 24

DMARDS + steroids and NSAIDs

Question 25

DMARDS = which is first line? principle of therapy for RA =

Answer 25

methotrexate (1st line)> + sulfasalazine > + hydroxychloroquine others = leflunomide, gold injection + azathioprine rapid escalation until remission

Question 26

starting dose of methotrexate = maximum = must give ___ supplement with it

Answer 26

15mg/wk 25mg/wk folic acid

Question 27

dose of sulfasalazine = | avoid in __+__

Answer 27

40mg/kg/day | septrin allergy and G6PD deficiency

Question 28

dose of hydroxychloroquine = | for ___ RA

Answer 28

200-400mg/day | palindromic

Question 29

if on DMARDS then regularly monitor (4)

Answer 29

LFTs FBC CXR contraception (teratogenic)

Question 30

drug that causes an allergic pneumonitis as a possible side effect

Answer 30

methotrexate

Question 31

only start biologics for RA if

Answer 31

2 DMARDS = no response | and DAS28 >5.1 on 2 occasions 4 wks apart

Question 32

if giving biologics for RA screen for (5) | avoid

Answer 32

latent tb, HIV, hep B+C, VZV | live attenuated vaccines

Question 33

``` biologics used in RA anti TNF = t cell receptor blocker = B cell depleter IL6 blocker Jak 2 inhibitor = ```

Answer 33

``` infliximab, adalimumab, etanercept, certolizumab, golimumab = TNF abatacept = T rituximab = B tocilizumab = IL6 tofacitinib = Jak2 ```

Question 34

see RA patient every ___ until remission and then every ___

Answer 34

1-3 months | 3-6 months

Question 35

if possible atlanto-axial subluxation get __+__ xrays

Answer 35

flexed and extended

Question 36

marginal joint erosion is the hallmark of

Answer 36

RA