Rheumatoid Arthritis Flashcards

(38 cards)

1
Q

what is rheumatoid arthritis (RA)?

A

symmetrical inflammatory arthritis affecting peripheral joints

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2
Q

what can RA cause?

A

joint damage

loss of function

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3
Q

does RA affect articular or extra-articular surfaces?

A

both

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4
Q

which gender is more likely to get RA?

A

women

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5
Q

prevalence in uk?

A

1%

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6
Q

which is the only area of the spine typically affected and why?

A

C1 and C2

only part of the spine that contains synovium

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7
Q

what comorbidities increase risk of RA?

A
psoriasis
kidney problems
CV problems
crohns
peripheral nerve problems
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8
Q

what is RA in children under 16 called?

A

juvenile idiopathic arthritis

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9
Q

triggers of RA?

A

smoking
infection
stress

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10
Q

what happens to the synovium in RA?

A

becomes hypertrophic and inflamed

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11
Q

what joints does RA affect

A

synovial joints

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12
Q

what other joints are synovium lined?

A
hand
wrist
elbows
shoulders
TMJs
knees
hips
ankles
feet
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13
Q

2 hallmarks of RA

A

tenosynovitis

synovitis

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14
Q

what is a pannus

A

inflamed spongy synovium

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15
Q

what is the pathogenesis of RA

A

antigen taken up by dendritics -> presented via AP cell to T cells-> inflam cascade

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16
Q

what pathogenic effects do osteoclasts have on the joint

A

erosion of bone

17
Q

what pathogenic substances are produced by B cells?

A

rheumatoid factor

IL-4

18
Q

what area other than joints is synovium present?

A

tendon sheath

19
Q

what time frame constitutes early RA?

A

<2 years since symptom onset

20
Q

what score on the ACR classification does someone need to have definite RA?

21
Q

main symptoms of RA?

A

stiffness (in morning >30 mins)
swelling
pain
SYMMETRICAL

22
Q

methods of diagnosis?

A

clinical exam
MRI
X ray
US

23
Q

clinical presentation of RA?

A
PIP/MCP/MTP/wrist synovitis
monoarthritis (will turn into RA)
tenosynovitis
trigger finger
carpal tunnel
polymyalgia
palindronic rheumatism
poor grip
systemic symptoms
24
Q

what is carpal tunnel syndrome in the case of RA?

A

compression of the median nerve by synovial tissue

25
what 2 autoantibodies are present in RA?
anti CCP | RF
26
which is the more prevalent of the autoantibodies in RA?
RF
27
what's better US or X rays for RA?
US
28
how many joints can be affected in RA?
32
29
how many joints are recorded on the DAS score?
28
30
what would a DAS score of >5.1 indicate?
active disease
31
what would a DAS score of 3.2-5.1 indicate
moderate disease
32
what would a DAS score of 2.6-3.2 indicate?
low disease activity
33
what would a DAS score of <2.6 indicate?
remission
34
pyramid of treatment for RA?
``` steroids/NSAIDS until DMARDS kick in methotrexate sulfasalazine hydroxychoroquine combo therapy (MTX+SASP+HCQ) leflunomide gold injections/azathiprine ```
35
what dose of methotrexate should you start a patient on
15mg/week
36
what should you always give 24 hours after methotrexate dose?
folic acid
37
what lung problem can be caused when taking methotrexate?
pneumonitis
38
when would you consider a biologic agent?
failure to respond to 2 DMARDs and DAS28 >5.1