Rheumatoid Arthritis Flashcards Preview

MDD BAB > Rheumatoid Arthritis > Flashcards

Flashcards in Rheumatoid Arthritis Deck (17)
Loading flashcards...
1
Q

What is rheumatoid arthritis ?

A

Rheumatoid arthritis is a long-term auto-immune condition which causes inflammation of our joints and often occurs in younger individuals.
Autoimmune means that; the immune system, our body’s defence system starts to attack specific joints as it mistakenly sees them as foreign dangerous. This results in pain, stiffness and swellings in the joints. The joints mainly affected are the ones in your hands, wrist and feet. It can also affect larger joints too.

2
Q

What are the symptoms of Rheumatoid arthritis? (4)

A
  1. Pain which improves with exercise and is worse first thing in the morning
  2. Morning stiffness lasting longer than 1 hour
  3. Swollen/warm joints (in acute phase)
  4. Deformities
3
Q

Name and describe the 5 deformities of Rheumatoid arthritis ? 😭

A
  1. Swan neck: hyperextension of DIPs and hyperextension of PIPs
  2. Boutonniere’s: hyperextension of PIPs and hyperextension of DIPs
  3. Z thumb: Hyperflexion of MCPs and Hyperextension of IPs
  4. Ulnar deviation
  5. Subluxation
4
Q

What is the mnemonic for the clinical features of Rheumatoid arthritis?

A

ANTI-CCP Or RF

5
Q

What are the clinical features of Rheumatoid arthritis? 😭

A

Arthritis: Symmetrical polyarthritis affecting PIPs and MCPs of hands and feet, but can also affect larger joints. DIPs are spared
Nodules: Firm, non tender, mobile/fixed nodules; commonly found on ELBOWs but also on heels and MCPs
Tenosynovitis: De Quervain’s Tenosynovitis;
Atlanto-axial subluxation of cervical spine
Immunology: Vasculitis, Amyloidosis: Affecting Kidneys: Nephrotic syndrome and Renal failure
Cardiac: Pericardial effusions and pericarditis
Carpal tunnel syndrome and peripheral neuropathy (Glove stocking pattern)
Pulmonary: Pulmonary Fibrosis; Fibrosing alveolitis and exudative pleural effusions
Ophthalmology: Episcleritis/Scleritis and Secondary Sjogren’s: Dry eyes and mouth
Raynaud’s
Felty’s Syndrome: RANS: RA, anaemia, Neutropenia and Splenomegaly

6
Q

What are the investigations done for Rheumatoid arthritis with regards to the FF: 😭
Bloods (3)
Special bloods (3)
Imaging (1)

A

Bloods: FBC (Normocytic anaemia) increased WCC and platelets in acute disease), ESR and CRP (increased in acute disease)
Special bloods (3): Anti- CCP (98% specificity), RF +ve (70% +ve, but non-specific) and ANA +ve in 30%
Imaging (2): X-Ray: 2 Views

7
Q

What are other forms of imaging

can be used for Rheumatoid arthritis ?

A
  1. USS and MRI
8
Q

What is the mnemonic for the X-day features of Rheumatoid arthritis?

A

LPD S2

9
Q

Describe the X-ray features of Rheumatoid arthritis

A
loss of joint space
Periosteal erosions
Deformities
Soft-tissue swellings
Subluxation
10
Q

How will you manage someone who suspect is suffering with rheumatoid arthritis ?

A

If in GP, referral to Rheumatology for further assessment and treatment; explain the management

If in Hospital, Get Senior review and then explain the management

11
Q

The management of Rheumatoid arthritis adopts a what approach ?

A

MDT approach

12
Q

Describe the management with regards to the Ff:

  • conservative (3)
  • Medical (3) including the 2nd and 3rd Line treatment
  • Surgery (3)
A

conservative: ROP: Rheumatology, OT and physiotherapist
- Medical: NSAIDs + Oral DMARDs; Methotrexate,
Steroids short-term and in acute disease: IM prednisolone
,2nd Line: 2 DMARDs
3rd Line: Biological agents
- Surgery: Synovectomy, Excision arthroplasty and Total joint replacement

13
Q

what are the symptoms of Atlantoaxial subluxation of cervical spine and 2 Ix ?

A

Localised cervical pain and deformity

Ix: X-ray/CT C-spine

14
Q

Examples of DMARDS (4)

A

methotrexate, sulphasalazine, hydroxychloroquine and leflunomide

15
Q

Biological agents

A

anti-TNF and Anti B cell therapies

16
Q

With regards to Rheumatoid arthritis treatment, how would you treat acute disease ?

A

Short course of oral prednisolone + methotrexate

17
Q

For rheumatoid arthritis, if a patients condition is stable yet they continue to have pain. What should you prescribe ?

A

Paracetamol