Rheumatoid Arthritis

Question 1

RA Definition

Answer 1

Chronic autoimmune systemic illness

characterised by symmetrical peripheral arthritis

and other systemic features

Question 2

RA diagnosis needs a score of x according to 2010 EULAR Classification

Answer 2

6 OR MORE out of 10

Question 3

4 sub-categories of RA Classification/Criteria

In each sub-category, what would score high pointing to a dx of RA?

Answer 3

Joint Involvement (poly + small joints)

Serology (RF +ve, ACPA +ve)

Acute phase reactants (raised)

Duration of symptoms 6w

Question 4

Epidemiology of RA

Gender

Prevalence

Peak age of onset

But may occur at any age from ____

Answer 4

F:M 3:1

1% of population

4th or 5th decade

But may occur at any age from 16 y

Question 5

Aetiology RA

Genetic - closest association with specific amino acid sequences at positions ____ of _____

Environmental factors (2)

Answer 5

Genetic - closest association with specific amino acid sequences at positions 70-74 of DRb1

Environmental factors:

Smoking

Chronic infection - peri-odontal disease

Question 6

Pathogenesis RA

3 stages

Answer 6

Rheumatoid factor binding to IgG forming immune complexes

Not easily cleared

Activate complement - further inflammation

Activation of macrophages

Question 7

RA Symptoms 4

Answer 7

Pain

Swelling

Loss of function

Systemic symptoms

Question 8

Symptoms RA

• Systemic symptoms
  
  • Non-specific (3)

Answer 8

Fatigue

Weight loss

Anemia

Question 9

Which types of malignancy have higher incidence assoc with RA

Answer 9

Leukemia and Lymphoma

Question 10

RA Clinical Signs (5)

Answer 10

Swelling

Tenderness

Limitation of ROM

• Redness*
• Heat*

Question 11

Investigations RA (5)

Answer 11

Immunology

• RF
• ACPA or Anti-CCP

X-rays

USS

Raised CRP/ESR

DAS28 score

Question 12

DAS28 score - how does it relate to RA?

What score represents clinical remission?

What score indicates eligibility for biology therapy

Answer 12

DAS28 score – monitor disease activity (disease activity score)

DAS<2.4 represents clinical remission

DAS>5.1 represents eligibility for biologic therapy

Question 13

4 modes of management of RA

Answer 13

NSAIDS

DMARDS

Biologics

Corticosteroids

Question 14

Name 4 DMARDs used in RA

Whats the gold standard DMARD drug

Answer 14

Methotrexate

Sulfasalazine

Hydroxychloroquine

Leflunomide

Question 15

Name 5 drugs under ‘Biologics’ category of RA MX

Answer 15

TNF-alpha inhibitors

IL-1 inhibitors

IL-6 inibitors Tocilizumab

Anti-B cell therapy - Rituximab

Anti-T cell therapies - Abatacept