23 - Clinical Rheumatoid Arthritis Flashcards
M:F?
F>M - 3:1
what is peak age of onset?
4/5th decade
when can RA be diagnosed?
after 16 yrs old
name 2 types of causes of RA?
genetic and environmental
how is incidence related to family history?
incidence rises in siblings by 2-4% and in twins by 12-15%
how is RA genetically associated with incidence?
Specific amino acid sequences at positions 70-74 of DRB1 (shared epitope)
name 2 environmental factors which increases risk of RA?
smoking, chronic infection (e.g. periodontal disease)
name 4 types of cells involved in synovial pannus of RA?
T lymphocytes, macrophages, fibroblasts plasma cells, endothelium dendritic cells
what cells are present in synovial fluid during RA?
neutrophils
name 4 immunological investigations for RA?
rheumatoid factor, ACCA, ESR, CRP
what is seen in rheumatoid factor immunology for RA?
IgG and IgM
what is seen in ACCA immunology for RA?
CCP, ACPA
which imagining should be used to investigate RA?
MRI/ x-ray
acronym to remember symptoms of RA?
PIPSS
name 5 symptoms of RA?
Pain, Immobility, Poor function, Systemic symptoms, Stiffness
3 signs of RA?
swelling, tenderness and limitation of movement
3 non-specific symptoms of RA?
anaemia, weight loss, fatigue
2 long-term systemic risks associated with RA?
CVS, malignancy
severity scoring?
DAS - disease activity score
what does DAS <2.4 mean?
clinical remission
what DAS score corresponds with eligibility for biologic therapy?
> 5.1
how does RA affect life expectancy?
shortens by 7 years
how many people have to stop working after 2 years of diagnosis of RA?
~33%
how many people have to stop working after 10 years of diagnosis of RA?
~50%
when does stiffness of joints typically present?
in morning
name 2 radiological changes seen in RA?
erosions, bony decalcification
2 types of drugs for RA?
DMARDs and biologics
name 4 DMARDs?
methotrexate, leflunomide, hydroxychloroquine, sulfasalazine
1st line treatment?
methotrexate with other DMARD/ biologic + corticosteroids
name 4 side effects of methotrexate?
nausea, hair loss, sore mouth, diarrhoea
monitoring while on methotrexate?
regular bloods (LFTs etc.) and CXR on starting treatment
name a biologic?
infliximab
when are biologics used?
alongside DMARDs - often to augment their efficacy
how are biologics administered?
Injection
name 4 potential SEs of biologics?
headaches, infection, irritation @ injection site, high T
name 1 serious complication associated with biologics?
reactivation of TB
name 2 types of JAK inhibitors?
tofacitinib and baricitinib
how are JAK inhibotrs taken?
once/twice daily, either alone or with methotrexate
name 4 potential drugs used for pain management in RA?
paracetamol, codeine, ibuprofen and naproxen
If given NSAIDs for analgesia, what will you be required to take with these and why?
PIPs - to reduce stomach acid
when can steroids be used in RA?
short term relief - e.g. when waiting for DMARDs to take effect
name a steroid used in RA?
prednisolone
3 SEs of steroids?
thinning of skin, weight gain and osteoporosis
name 3 supportive treatments of RA?
physio, podiatry and OT
which treatment can be used to remove inflamed joint tissue?
arthroscopy
last resort treatment?
joint replacement - arthroplasty
