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MSK > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is the definition of RA?

A

Symmetrical inflammatory arthritis affecting mainly the peripheral joints which if untreated can lead to joint damage and irrevesible deformities leading to loss of function and increased morbidity and mortality

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2
Q

What areas of the spine can RA affect?

A

C1 and C2 as these are the only areas with synovial fluid

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3
Q

What gene mediates RA?

A

HLA-DR4

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4
Q

What are environmental triggers of RA?

A

Infections
Stress
Cigarette smoking

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5
Q

What is the main structure involved in RA?

A

Synovium (lining of inside of syovial joint capsules and tendon sheaths)

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6
Q

What joints are commonly affects by RA?

A 
C1/C2
Hand joints: PIP, MCP, CPC
Elbows
Shoulders
TMJs
Knees
Hips
Ankles
Feet
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7
Q

What is a pannus?

A

Inflammation and proliferation of the synovium leads to formation of pannus and destruction of cartilage, bone, tendons, ligaments, and blood vessels. Basically, the hypertrophied synovium is called pannus.

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8
Q

What is the immunopathogenesis of RA?

A

Antigen present to T cell and will activate this. This will cause the activation of macrophages to release pro-inflammatory cytokines
It will also cause B cells to be activated leading to the producion of Rheumatoid factor

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9
Q

What pro-inflammatory cytokines will macrophages produce?

A

TFN-alpha
IL-1
IL-6

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10
Q

What will inflammation in the joint and release of pro-inflammatory cytokines and RF result in?

A

Osteoclast stimulation
Formation of pannus
Joint destruction

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11
Q

What is early RA?

A

Less than 2 years than symptoms onset

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12
Q

What effect can drugs in the first 3 months of symptoms have?

A

Disease modifying window

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13
Q

How is RA diagnosed?

A 
History and clinical examination 
Routine blood testing - anaemia or raised platelets
Inflammatory markers (CRP, ESR/PV)
Autoantibodies
Imaging
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14
Q

What systemic involvement can be present with RA?

A

SOB
Coughing
Chest pain
Lung and kidney involvement is common

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15
Q

What classification critera is used for RA?

A

ACR/Eular

>6 points is definite RA

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16
Q

What are the clinical features of RA?

A

Prolonged morning stiffness
Involvement of small joints of hands and feet
Symmetric distribution
Positive compression tests of MCP and MTP joints

17
Q

What are the clinical presentations of RA?

A 
PIP, MCP, wrist and MTP synovitis
Monoarthritis
Tenosynovitis
Trigger finger
Carpal tunnel syndrome 
Polymyalgia rheumatica
Palindromic rheumatism 
Systemic symptoms
Poor grip strength
18
Q

What autoantibodies are associated with RA?

A

Rheumatoid factor

Anti-CCP antibodies

19
Q

What imaging modalities are utilised for RA?

A

Plain x-ray
Ultrasound scanning
MRI

20
Q

What can plain x-rays show?

A

Soft tissue sweeling

Osteoclast activation will cause erosion

21
Q

What can ultrasounds detect?

A

Detect up to 7x more MCP erosions than plain x-rays in early RA
Will detect increased blood flow to inflammed synovium

22
Q

What can MRIs detect?

A

Bone marrow oedema on MRI is associated with inflammatory joint disease and a forerunner of erosion
Integrity of tendons
Can distinguish synovitis from effusions

23
Q

What is DAS28?

A

Assessment of disease activity score

24
Q

What are the different scores in DAS28?

A

> 5.1 is active disease
3.2-5.1 is moderate disease
2.6-3.2 is low disease activity
Less than 2.6 is remission

25
Q

What is the use of steroids in RA?

A

Important in management in RA, serve as a bridge between diagnosis and immunosuppresant therpay as these take about 6-8 weeks to take effect

26
Q

What can be used for pain in RA?

A

NSAIDs; diclofenac, ibuprofen, aspirin, naproxone, indomethacin

27
Q

What is the RA treatment pyramid?

A 
Asprin/ NSAIDs
Steroids
DMARD #1
DMARS #2
DMARS #3
28
Q

What are DMARDs used in RA?

A

Methotrexate
Sulfalazine
Hydroxychloroquine
Steroids - short term

29
Q

When will biological agents be deployed?

A

If on 3 DMARDs but DAS28 is still above 5.1

30
Q

What is the dosage of methotrexate?

A

15mg with rapid escalation to 25mg a week

Folic acid 24hrs after MTX dose

31
Q

What blood tests need to be performed whilst on DMARDs?

A

LFTs

FBC

32
Q

What lung problem can MTX cause?

A

Pneumonitis

33
Q

What is a swan neck deformity?

A

DIP flexion with PIP hyperextension

34
Q

What is boutonnieres deformity?

A

PIP flexion with DIP hyperextension

35
Q

What pregnancy councelling needs to be given for patients with RA?

A

Methotrexate is teratogenic, so if wanting to start a family, methotrexate needs to be stopped by males and females 3 months before conception, during pregnancy and during breast feeding
Switch to alternative such as suflalazine which is safe in pregnancy

MSK (34 decks)

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