Seropositive Inflammatory Arthropathies (mainly RA) Flashcards
(30 cards)
What are symptoms suggestive of inflammatory arthropathies?
joint pain & swelling morning stiffness improvement of symptoms with exercise synovitis with examination raised inflammatory markers extra-articular symptoms
What are general options for treatment of inflammatory arthropathies?
analgesia
anti-inflammatory medications: steroids & NSAIDs
steroid injections
DMARDs
What are seropositive inflammatory arthropathies?
Rheumatoid Arthritis SLE Scleroderma Vasculitis Sjogren's
What is the most common seropositive inflammatory arthropathy?
Rheumatoid artritis
Pathogenesis of RA
Auto-immune inflammatory systemic polyarthropathy
There is an immune response against synovium - inflammatory pannus forms which attacks & denudes articular cartilage
joint destruction, tendon ruptures, soft tissue damage
joint instability, subluxation
F:M ratio of RA
3:1
prevalence of RA
1% of population, increasing prevalence with age
Age RA usually diagnosed at
35-50
Genetic & Environmental factors of RA
genetic factors: 50% of the risk
smoking & RA association
Signs & Symptoms Of RA
symmetrical synovitis (doughy swelling)
mainly small joints of hands & feet
DIP spared!!!
morning stiffness
extra-articular manifestation of RA
rheumatoid nodules - 25$ extensor surfaces/mechanical irritation sites
lung: pleural effusion, interstitial fibrosis, pulmonary nodules
CV: morbidity & mortality increased
ocular involvement
ocular involvement of RA
keratoconjunctivitis sicca
episcleritis
uveitis
nodular scleritis - sleromalacia
What is a joint that RA may affect and could be life-threatening?
C1-2
investigations of RA
X-Ray: peri-articular osteopenia, periarticular erosions later in disease (at onset it may not show anything)
US: synovial inflammation
Serology: Rheumatoid Factor, Anti-CCP (more specific)
Serology of RA
Rheumatoid Factor
Anti-CCP (more specific)
15-20% of RA patients are seronegative
Diagnosis of RA is based on
clinical presentation
radiographic findings
serological analyiss
ACR & EULAR RA criteria scoring system
Disease activity is measured by
DAS28: tender joint count, swollen joint count, CRP/ESR, visual analogue score
DAS28 score limits
DAS28 < 2.6 - remission
DAS28 2.7-3.2 - low disease activity
DAS28 3.3-5.1 - moderate disease activity
DAS28 > 5.1 - high disease activity (eligible for biologic)
Symptom relief in RA
simple analgesia
NSAIDs
steroids: IM/intra-articular/oral
Treatment pattern for RA
1 DMARD: methotrexate (1st line)
2 DMARDs: methotrexate & sulfalazine
Biologic therapy (if it doesn’t respond to DMARDs & has high DAS28 score)
What is the critical window for DMARD therapy to be started?
It should be started within the first 3 months of symtpom onset
DMARDs
methotrexate
sulphalazine
hydroxychloroquine
leflunomide
Side effects of DMARDs
immunosuppressive - need to monitor bloods
What does taking the drugs look like for someone on methotrexate?
pregnancy test before starting
contraception has to be taken
regular blood tests
methotrexate 1/ week - 15 mg start
folic acid 1/week (3 days after drug)
