Rheumatoid arthritis Flashcards
(22 cards)
describe the epidemiology of RA
- increased risk in smokers
- x2 more common in females
- around 1% population
- peak onset 4th-5th decade
what joints are typically swollen
PIP
MCP
give some signs seen on the dorsum of the hand
symmetrical swelling of PIP and MCP joints
ulnar deviation at MCP joints
thin skin
wasting of intrinsic muscles (hypothenar and thenar eminence)
describe a swan neck deformity
flexion of the DIP
hyperextension PIP
describe a boutonniere deformity
flexion PIP
extension DIP
where might you see rheumatoid nodules
extensor tendons
joints
sites of mechanical irritation
when is the pain worst in the joints
morning
what eye complications are associated with RA
- episcleritis
- scleritis
- scleromalacia
what antibodies are specific for RA
anti-CCP
what percentage of patients are positive for rheumatoid factor
70%
what can you offer as a short term treatment for flares of RA
glucocorticoids
what is the first line treatment for RA
DMARDs
give some DMARDs
methotrexate
sulfasalzine
hydrocholorquine
what might joints feel like on palpation
warm and tender
in what joints might you see volar subluxation
MCP + wrist joints
what should you screen for before starting a biologic drug
TB, Hep B/C, HIV
give some TNFa inhibitors
infliximab
adalimumab
when can you consider a biologic drug
for patients with active disease despite trial with at least 2 DMARDs
give two drugs which cause B cell depletion
rituximab
methotrexate
what is the first line biologic drug
TNF a inhibitors
how does abatacept work
inhibition of T cell co-stimulation
give some side effects of biologics
serious infection TB reactivation/Hep B worsening HF hypersensitivity ANA and reversible SLE type illness
