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MSK > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

name the 4 groups that inflammatory arthropathies can be subdivided into

A

seropositive
seronegative
infectious
crystal deposition disorders

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2
Q

type of pharmacological treatment for inflammatory arthropathies?

A

simple analgesia
steroids and steroid injections
NSAIDs
DMARDs - disease modifying anti-rheumatic drugs

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3
Q

is RA symmetrical?

A

yes

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4
Q

is psoriatic arthritis symmetrical?

A

no

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5
Q

where does AS affect?

A

spine mainly but also shoulder, hip and knee

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6
Q

features of inflammatory arthritis:

____ and swelling

________ stiffness

improvement with ________

synovitis

raised ____________ markers such as ___ and __

A

features of inflammatory arthritis:

PAIN and swelling

MORNING stiffness

improvement with EXERCISE

synovitis

raised INFLAMMATORY markers such as CRP and PV

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7
Q

name the most common seropositive arthritis

A

RA

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8
Q

what is RA?

A

auto‐immune inflammatory symmetric polyarthropathy

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9
Q

what does RA affect?

A

small joints of hand and feet but also large joints such as knees, shoulders and elbows

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10
Q

what sex is more affected by RA?

A

females

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11
Q

peak age range or RA?

A

35-50

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12
Q

are genetics important in RA?

A

yes - 2-3x higher risk is family member is affected

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13
Q

what lines the synovial joints?

A

synovium - this is attacked in RA

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14
Q

name triggers of RA

A

smoking, infection and trauma lead to disease process of immune response against the synovium

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15
Q

an inflammatory ______ forms which attacks and denudes articular cartilage leading to joint destruction

A

an inflammatory PANNUS forms which attacks and denudes articular cartilage leading to joint destruction

after synovium is attacked

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16
Q

what can rupture in RA?

A

tendon rupture and soft tissue damage can occur leading to joint instability and subluxation

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17
Q

name the 2 antibodies important RA

A

rheumatoid factor and anti-CCP (anti-citrullinated protein antibody)

18
Q

clinical features of RA in hand(s)?

A

symmetrical synovitis (doughy swelling)
pain
morning stiffness

19
Q

what joints are affected in the hand in RA?

A

MCPs and PIPs

NOT DIPs

20
Q

what part of the spine is affected in late RA?

A

cervical spine - atlanto-axial subluxation which can result in cervical cord compression

21
Q

what skin manifestation is found in 25% of those with RA?

A

rheumatoid nodules - extensor surfaces

22
Q

lung involvement of RA?

A

pleural effusions, fibrosis and pulmonary nodules

23
Q

is CVS risk and mortality increased in those with RA?

A

yes

24
Q

is ocular involvement common in those with RA?

A

yes

keratoconjunctivitis sicca
episcleritis
uveitis
nodular scleritis that may lead to scleromalacia

25
Q

what antibody is more specific in those with RA?

A

anti-CCP

26
Q

what markers are raised in RA?

A

CRP and PV

27
Q

early XR features of RA?

A

peri-articular osteopenia and soft tissue swelling

periarticular erosion in later disease

28
Q

what scan may be useful in detecting synovial inflammation if there is clinical uncertainty?

A

US

29
Q

what treatment should be initiated in a 3 month onset of RA?

A

DMARDs

30
Q

short term treatment for RA?

A

simple analgesia
NSAIDs
IM/IA/oral steroids

31
Q

first line DMARD for RA?

A

methotrexate

32
Q

other DMARDs for RA?

A

sulphasalazine, hydroxychloroquine and leflunomide

33
Q

what do DMARDs cause?

A

immunosuppression - increased risk of infection and marrow suppression

34
Q

monitoring of what is required for DMARD therapy?

A

blood

35
Q

what if DMARDs don’t work in RA?

A

biologics

anti-TNF

toclizumab, rituximab and abatacept

36
Q

main increased risk of in biologics use?

A

TB

37
Q

what scoring system is used in RA?

A

DAS28/DAWN

38
Q

DAS 28 < 2.6 = Remission

DAS 28 2.7-3.2 = Low disease activity

DAS 28 3.3-5.1 = Moderate disease activity

DAS 28 >5.1 = High disease activity

which do you need for biologics?

A

DAS 28 >5.1

39
Q

can the following be treatments in RA:

synovectomy
joint replacement
joint excision
tendon transfers
arthrodesis (fusion)
cervical spine stabilisation
A

yes

40
Q

physiotherapists, occupational therapists, podiatrists and orthotists do not have an important role in RA treatment

true or false?

A

false

MSK (12 decks)

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