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MSK > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

Chronic autoimmune inflammatory disorder - systemic disease

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2
Q

What causes RA?

A

Genetic susceptibility + environmental factors

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3
Q

Describe the pathogenesis of RA

A
  1. Altered post translational regulation (A-C)
  2. Citrullinated protein changed shape and acts as an antigen
  3. Anti-CCP antibodies and CCP antigen lead to the formation of immune complexes
  4. Immune complexes get deposited in the synovia which triggers an inflammatory reaction
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4
Q

Describe the immunological response to the CCP antigen

A

T cells - produce cytokines (IFN gamma, IL17, TNF, IL1)

B cells - produce antibodies (IgG and rheumatoid factor)

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5
Q

What happens to the structure synovium due to inflammation?

A

Villous folds form and hyperplasia occurs, fibrin matts the folds together and can form rice bodies on the surface. Granulation tissue can also form.

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6
Q

What is the name given to granulation tissue that grows over the articular surface?

A

Pannnus

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7
Q

If pannus impacts cartilage nutrition what will the result be?

A

Degradation of the matrix which is irreversible

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8
Q

What may happen if lots of articular cartilage is lost>

A

Granulation tissue from both sides of the joint may form adhesions and fuse the joint

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9
Q

What is the nave given to fusion of joints?

A

Fibrous ankylosis

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10
Q

State four main consequences of the inflammatory reaction on the joint structure

A
  • thickened synovial membrane
  • cartilage wears away
  • bone erosion
  • reduced joint space
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11
Q

State the clinical features of RA found in the joints

A

Prolonged morning stiffness (>30mins), involvement of hands and feet (PIPs/MCPs/MTPs), symmetrical positive compression of MCP/MTP. Synovitis.

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12
Q

What investigations are carried out on a patient with RA?

A

Auto-Antibody testing
X-ray
Ultrasound
MRI

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13
Q

What auto-antibodies are tested?

A

Rheumatoid Factor

Anti-CCP (more specific, can be present before symptoms and correlates to disease activity and smoking)

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14
Q

Describe the X-ray findings in RA

A

Early disease - normal, soft tissue swelling, osteopenia

Late disease - erosions, subluxation

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15
Q

What will an Ultrasound in RA show?

A

Sensitivity for synovitis, can be used to detect MCP erosions

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16
Q

State the extra-articular manifestations of RA

A
  • small vessel vasculitis
  • cardiovascular risk
  • pulmonary disease
  • ocular/oral disease
  • GI tract
  • renal
  • neurological
  • haematological (anaemia)
  • rheumatoid nodules
17
Q

What are rheumatoid nodules and where are they found?

A

Central collagen necrosis surrounded by palisading macrophages usually found on pressure points but can be on internal organs

18
Q

What are the ocular manifestations of RA?

A

Episcleritis and keratoconjunctivitis

19
Q

What cancer are patients with RA at increased risk of?

A

Lymphoma

20
Q

What is the risk of pulmonary disease in RA?

A

Drugs may collect in an effusion

21
Q

State the first line treatment for RA

A

Methotrexate

22
Q

If methotrexate is contraindicated what else can be used?

A

Other disease modifying anti rheumatic drugs

  • sulfalazine
  • hydroxychloroquine
  • leflunomide
23
Q

What are the side effects of DMARDs?

A

Bone marrow suppression, infection, liver function derangement, pneumonitis, nausea

24
Q

How can methotrexate be administered?

A

Orally, subcutaneously, used in combination

25
Q

What is the contraindication of methotrexate?

A

It is teratogenic must be stopped 3 months prior to conception

26
Q

What is used to assess disease activity of RA?

A

DAS28

27
Q

When is second line treatment for RA indicated?

A

After 2 DMARDs and DAS28 >5.1

28
Q

What are the second line treatment options for RA?

A 
Anti-TNF 
T cell receptor blocker 
B cell depleted 
IL-6 blocker 
JAK inhibitor

MSK (22 decks)

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