Female to male ratio for rheumatoid arthritis
Dose of sulfasalazine
Presentation of rheumatoid arthritis?
symmetrical distribution, positive compression test of the MCP and MTP joints, involvement of the small joints of the hands and feet, tenosynovitis, carpal tunnel syndrome
A DAS-28 score of <2.6 indicates?
What must patients be screened for before commencing biologic therapy? (5)
TB, Hep B/C, HIV, varicella zoster
A DAS-28 score of 2.6-3.2 indicates?
low disease activity
Which vertebrae may be affected by rheumatoid arthritis?
1st line treatment for rheumatoid arthritis
symmetrical inflammatory arthritis mainly affecting the peripheral joints
When should steroids be used in rheumatoid arthritis?
To start treatment until DMARDs kick in and to control flare ups
X-ray findings in more advanced rheumatoid arthritis?
erosions, soft tissue swelling, periarticular osteopaenia
Use of USS in rheumatoid arthritis?
good for detecting synovitis and 7x more MCP erosions than an x-ray
Side effect of methotrexate
may cause bone marrow suppression
Describe a swan neck deformity
Key clinical features pointing to an inflammatory rheumatoid disease
prolonged morning stiffness, fatigue, weight loss, fever
Describe a boutonniere deformity
A DAS-28 score of >5.1 indicates?
severe, active disease
A DAS-28 score of 3.2-5.1 indicates?
moderate disease activity
Complications of unresolved rheumatoid arthritis
Swan-neck deformities and boutonnieres, atlanto-axial subluxation
Example B cell depletor
Dose of methotrexate used initially in Rheumatoid arthritis?
What must be prescribed with methotrexate and why?
folic acid - MTX prevents the incorporation of folic acid into the joint
How are DMARDs typically prescribed?
as a combination therapy i.e. MTX, Sulfasalazien and hydroxychloroquine
Which auto-antibody test is more specific to rheumatoid arthritis?
X-rays in early rheumatoid arthritis may show?
nothing or some soft tissue swelling
why is hydroxychloroquine prescribed alongside methotrexate?
it does not prevent erosions
Ideal timescale for starting rheumatoid arthritis treatment?
3 months from symptom onset
How is methotrexate best taken?
parenterally to provide best bioavailability i.e. IM, IV
3rd line DMARD
Example anti-TNF agent