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Year 4 Longterm Conditions > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

what is RA?

A

autoimmune condition

chronic inflammation of synovial lining of joints, tendon sheath and bursa

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2
Q

synovial inflammation

A

synovitis

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3
Q

joint distribution

A

symmetrical

multiple joints

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4
Q

women or men?

A

3x more women

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5
Q

genetic associations

A

HLA DR4

HLA DR1

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6
Q

Antibodies

A

RF

Anti-CCP

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7
Q

RF

A

autoantibody in 70% RA

targets Fc portion of IgG

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8
Q

Anti-CCP

A

autoantibodies - more sensitive and specific than RA

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9
Q

common presentation

A

symmetrical distal polyarthropathy

pain, stiffness, swelling

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10
Q

joints commonly affected

A

small joints of hands and feet
wrist, ankle, MCP, PIP
elbow, knee, shoulder

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11
Q

systemic symptoms

A

fatigue, weight loss, flu lie, muscle ache

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12
Q

RA vs OA pain

A

Pain RA worse after rest, better with activity

OA opposite

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13
Q

DIP affected?

A

NO

heberdens nodes

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14
Q

complication which can occur in spine

A

atlantoaxial subluxation
axis and odontoid peg
spinal cord compression

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15
Q

how do the joints feel?

A

boggy

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16
Q

4 key hand findings

A

ulnar deviation MCP
swan neck deformity
z deformity of thumb
boutonnieres deformity

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17
Q

swan neck deformity

A

hyperextended PIP with flexed DIP

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18
Q

boutonnieres deformity

A

hyperextended DIP with flexed PIP

tear in central slip of extensor compartment

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19
Q

Extra-articular manifestations

A 
pulmonary fibrosis 
secondary sjogrens 
feltys syndrome 
anaemia chronic disease
carpal tunnel syndrome 
amyloidosis 
bronchiolitis obliterans
20
Q

feltys syndrome

A

RA
splenomegaly
neutropenia

21
Q

investigations

A

clinical examination
check RF, Anti-CCP
CRP, ESR
x-ray of hands and feet

22
Q

use of USS

A

evaluate and confirm synovitis

23
Q

x-ray changes

A

Joint destruction and deformity
soft tissue swelling
periarticular osteopenia
bony erosions

24
Q

ACR diagnostic criteria

A

joints involved - more and smaller
serology - RF, anti CCP
inflammatory markers
duration <6 weeks

25
Q

ACR score diagnosis

A

6

26
Q

What score can be used to monitor disease?

A

DAS28

27
Q

DAS28 score

A

assessment for 28 joints

swollen, tender, ESR/CRP

28
Q

questionnaire for functional ability

A

HAQ

29
Q

what indicated worse prognosis?

A 
younger 
male 
more joints and organs affected
RF and anti CCP
erosions on x-ray
30
Q

first presentations treatment

A

steroids

NSAIDs/COX-2 inhibitors (plus PPI)

31
Q

first line DMARD

A

methotrexate or sulfasalazine

32
Q

hydroxychloroquine?

A

mild disease

33
Q

3rd line and 4th line treatment

A

MTX + TNF inhibitor

MTX + rituximab

34
Q

DMARDs in pregnancy

A

HCQ and sulfasalazine

35
Q

examples of TNF inhibitors

A

adalinumab
etanercept
infliximab

36
Q

what type of drug is rituximab?

A

anti-CD20

37
Q

How does MTX work?

A

interfere with folate metabolism

suppress parts of immune system

38
Q

How is MTX given?

A

injection or tablet once a week

39
Q

what is given with MTX?

A

folic acid 5mg

taken on a different day

40
Q

side effects of MTX

A 
mouth ulcers 
liver toxicity 
pulmonary fibrosis 
teratogenic 
bone marrow suppression
41
Q

Leflunomide

A

interfere with pyrimidine

peripheral neuropathy and teratogenic

42
Q

sulfasalazine - need folate?

A

yes if pregnant

43
Q

notable side effects sulfasalazine

A

temporary male infertility

bone marrow suppression

44
Q

how does HCQ work?

A

classically an anti-malarial

interfere with toll like receptors

45
Q

side effects HCQ

A

nightmares
reduced visual acuity
liver toxicity

46
Q

side effects anti-TNF

A

vulnerable to severe infections and sepsis

reactivation of TB and hep B

47
Q

rituximab side effects

A

night sweats

thrombocytopenia

Year 4 Longterm Conditions (32 decks)

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