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MSK Year 3 > Rheumatoid Arthritis - Clinical > Flashcards

Rheumatoid Arthritis - Clinical Flashcards

1
Q

Symptoms of Rheumatoid Arthritis

A 
Hand joint pain
Morning joint stiffness for more than 30 minutes
Symptoms improve throughout the day
Joint swelling
Knee effusions
Bilateral swollen ankle
Raised ESR, CRP
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2
Q

Investigation/Review for RA Patient

A

Confirm widespread synovitis
Positive RF
Positive anti CCP antibody
Baseline hand and foot x ray

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3
Q

Treatment for RA

A

Glucocorticoids
Initiation of DMARD therapy
Patient information

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4
Q

Example of DMARD therapy

A

Sulfasalazine

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5
Q

Describe what is involved in an RA follow-up

A

Monthly appointments in Early Arthritis Clinic (nurse-led)

  • Monitor disease activity DAS28
  • Monitor blood test
  • Patient education
  • Multidisciplinary assessment
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6
Q

What HCPs are involved in an RA MDT?

A 
Specialist nurse
OT
Physio
Pharmacist
Clinical Psychologist
Podiatrist
Orthotics
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7
Q

What treatment can be given if patient experiences flare ups after initial DMARD therapy?

A

IM Steroid
Methotrexate
Biologics

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8
Q

What is assessed prior to initiating biologic treatment?

A

TB Vaccination scar
Chest x-ray
Chronic blood-borne viral screening
VZV Serology

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9
Q

Example of biologic used to treat RA

A

Anti-TNF alpha

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10
Q

What are the complications of RA?

A

Orthopaedic complications
Extra-articular involvement
Cardiovascular risk
Socioeconomic implications

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11
Q

What orthopaedic complications can occur due to RA?

A 
Chronic synovitis
Pain
Deformities
Poor function
Secondary osteoarthritis
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12
Q

Three examples of extra-articular involvement due to RA

A

Rheumatoid nodules
Interstitial lung disease
Vasculitis

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13
Q

Management of Functional Impairment associated with RA

A 
Vertebral fractures (can occur with OA)
Special adaptive cutlery
Adaptive footwear
Walking aids
Wheelchair
Family support
Care package
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14
Q

ARA 1987 Criteria for diagnoses of RA (7 points)

A 
Morning stiffness
Arthritis of 3 or more joint areas
Arthritis of hand
Symmetric arthritis
Rheumatoid nodules
Serum Rheumatoid Factors
Radiographic change
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15
Q

EULAR/ACR 2010 Criteria for RA diagnosis

A 
6 or more of 
Joint involvement - one large joint/2-10 small joints/ 1-3 small/4-10 small/greater than 10 
Serology
Acute Phase Reactants
Duration of Symptoms
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16
Q

2 factors to be eligible for investigation of RA under EULAR/ACR criteria

A

Definite clincal synovitis

Swelling cannot be explained by another illness

17
Q

Ratio of RA Male to Female

A

1 to 3

18
Q

Average age to be diagnosed with RA

A

Presents 4th/5th decade

19
Q

Genetic and environmental factors contributing to RA

A

Smoking
Chronic infection
HLA DRB 1

20
Q

Investigations for RA

A

Rheumatoid Factor - IgG, IgM

Anti CCP antibodies , ACPA

21
Q

Symptoms of RA

A 
Pain 
Stiffness
Immobility
Function
Systemic symptoms
22
Q

Signs of RA

A 
Swelling
Tenderness
Limitation of movement
Redness 
Heat
23
Q

Non-specfic systemic features of RA

A

Weight loss
Fatigue
Anaemia

24
Q

Specific systemic symptoms of RA

A 
Eyes 
Lungs
Nerves
Skin - nodules
Kidneys
25
Q

Long-term associations and risks of RA

A

Cardiovascular

Malignancy

26
Q

Assessment of RA - Disease Activity Score (DAS)

A

<2.4 Clinical remission

>5.1 eligible for biologic therapy

27
Q

4 Treatment approaches of inflammatory Arthritis

A

Medicines
Injections
Therapies
Surgeries

28
Q

Therapeutic categories for RA treatment

A

NSAIDs
DMARDs
Biologics
Corticosteroids

29
Q

4 examples of DMARDs

A

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide

30
Q

Treatment strategies for early aggressive intervention

A

Sequential Monotherapy
Combination
Targeted Therapy

31
Q

Mechanism of Biologics

A

Target aspects of inflammatory cascade

32
Q

Examples of Biologics

A 
Anti TNF alpha
IL-1 inhibitors
Anti B cell therapies - Rituximab
Anti T cell therapy - Abatacept
IL-6 inhibitors - Tocilizumab
33
Q

Biologic therapy will have an enhanced effect in RA in conjunction with which other medication?

A

Methotrexate -DMARD

34
Q

Methods of Corticosteroid administration

A

Oral, IV, IM

35
Q

What factors need considered when prescribing corticosteroids?

A

Short term benefit versus long term toxicity

Inappropriate as single drug therapy in most cases

MSK Year 3 (8 decks)

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