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MSK > 23 - Clinical Rheumatoid Arthritis > Flashcards

23 - Clinical Rheumatoid Arthritis Flashcards

1
Q

M:F?

A

F>M - 3:1

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2
Q

what is peak age of onset?

A

4/5th decade

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3
Q

when can RA be diagnosed?

A

after 16 yrs old

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4
Q

name 2 types of causes of RA?

A

genetic and environmental

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5
Q

how is incidence related to family history?

A

incidence rises in siblings by 2-4% and in twins by 12-15%

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6
Q

how is RA genetically associated with incidence?

A

Specific amino acid sequences at positions 70-74 of DRB1 (shared epitope)

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7
Q

name 2 environmental factors which increases risk of RA?

A

smoking, chronic infection (e.g. periodontal disease)

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8
Q

name 4 types of cells involved in synovial pannus of RA?

A

T lymphocytes, macrophages, fibroblasts plasma cells, endothelium dendritic cells

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9
Q

what cells are present in synovial fluid during RA?

A

neutrophils

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10
Q

name 4 immunological investigations for RA?

A

rheumatoid factor, ACCA, ESR, CRP

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11
Q

what is seen in rheumatoid factor immunology for RA?

A

IgG and IgM

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12
Q

what is seen in ACCA immunology for RA?

A

CCP, ACPA

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13
Q

which imagining should be used to investigate RA?

A

MRI/ x-ray

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14
Q

acronym to remember symptoms of RA?

A

PIPSS

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15
Q

name 5 symptoms of RA?

A

Pain, Immobility, Poor function, Systemic symptoms, Stiffness

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16
Q

3 signs of RA?

A

swelling, tenderness and limitation of movement

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17
Q

3 non-specific symptoms of RA?

A

anaemia, weight loss, fatigue

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18
Q

2 long-term systemic risks associated with RA?

A

CVS, malignancy

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19
Q

severity scoring?

A

DAS - disease activity score

20
Q

what does DAS <2.4 mean?

A

clinical remission

21
Q

what DAS score corresponds with eligibility for biologic therapy?

A

> 5.1

22
Q

how does RA affect life expectancy?

A

shortens by 7 years

23
Q

how many people have to stop working after 2 years of diagnosis of RA?

A

~33%

24
Q

how many people have to stop working after 10 years of diagnosis of RA?

A

~50%

25
Q

when does stiffness of joints typically present?

A

in morning

26
Q

name 2 radiological changes seen in RA?

A

erosions, bony decalcification

27
Q

2 types of drugs for RA?

A

DMARDs and biologics

28
Q

name 4 DMARDs?

A

methotrexate, leflunomide, hydroxychloroquine, sulfasalazine

29
Q

1st line treatment?

A

methotrexate with other DMARD/ biologic + corticosteroids

30
Q

name 4 side effects of methotrexate?

A

nausea, hair loss, sore mouth, diarrhoea

31
Q

monitoring while on methotrexate?

A

regular bloods (LFTs etc.) and CXR on starting treatment

32
Q

name a biologic?

A

infliximab

33
Q

when are biologics used?

A

alongside DMARDs - often to augment their efficacy

34
Q

how are biologics administered?

A

Injection

35
Q

name 4 potential SEs of biologics?

A

headaches, infection, irritation @ injection site, high T

36
Q

name 1 serious complication associated with biologics?

A

reactivation of TB

37
Q

name 2 types of JAK inhibitors?

A

tofacitinib and baricitinib

38
Q

how are JAK inhibotrs taken?

A

once/twice daily, either alone or with methotrexate

39
Q

name 4 potential drugs used for pain management in RA?

A

paracetamol, codeine, ibuprofen and naproxen

40
Q

If given NSAIDs for analgesia, what will you be required to take with these and why?

A

PIPs - to reduce stomach acid

41
Q

when can steroids be used in RA?

A

short term relief - e.g. when waiting for DMARDs to take effect

42
Q

name a steroid used in RA?

A

prednisolone

43
Q

3 SEs of steroids?

A

thinning of skin, weight gain and osteoporosis

44
Q

name 3 supportive treatments of RA?

A

physio, podiatry and OT

45
Q

which treatment can be used to remove inflamed joint tissue?

A

arthroscopy

46
Q

last resort treatment?

A

joint replacement - arthroplasty

MSK (26 decks)

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