4. Rheumatoid Arthritis Flashcards
Are women or men more likely to get RA and what age do they get it
Women, middle aged
What is a main risk factor for RA
smoking
What is the initial presentation of RA and how does it progress
Synovial joint inflammation, inflamed synovium gets invaded and cartilage and bone gets destroyed
May eventually have erosion and nodules in lade disease
How to diagnose RA
Pain, heat and swelling and loss of Fx in synovial joints, (no redness)
What immune cell is enriched in synovial fluid and pannus respectively
Neutrophils.
T cells and macrophages
Main presentation of RA
Tender inflamed joints- Swelling of joints, joint tenderness
systemic malaise, energy loss, severe morning stiffness at least 45 mins. Inactivity gelling, gets better with movement. May also have low grade fever, weight loss, depression and myalgia. Bilateral carpal tunnel may also appear before onset of arthritis
Most commonly affected joints in RA
MCPJ, PIPJ, IPJ of thumbs, wristss, and MTPJ
Which joints can be affected in poorly controlled RA
Elbows, shoulders, ankles and knees
What are features of PMR that may be present in pts
sever stiffness in proximal or pelvic girdle
What is palindromic RA
Palindromic RA- sever swelling and pain in one to several joint areas seq, usually less than a week, alternating with symptoms of free periods (months to days)
What drug can be used to prevent full blown rehumatism
Hydroxychloroquine
Where is axial involvement most likely in RA pts
Cervical spine- can lead to serious atlantal axial subluxation
What are some possible signs in RA
Wasted muscles from disuse or pain, nodules on elbows ( late arthritis), tenosynovitis- pt cannot make full fist due to thickening of flexor tendon sheaths.
What does symmetrical joint problems in hands suggest
more likely to be systemic inflammatory arthritis like RA or Pso A in young woman
What does synovitis of wrist present as in RA
Carpal tunnel Sx
How to classify RA and what is needed for diagnosis
Joint involvement
Serology
APR
Duration
score of 6 and above + Synovitis needed to be diagnosed
If sx of atrthritis are less than 6 weeks,what is it more likely to be
VIral arthritis
What are blood tests in RA likely to show
Anaemia, high platelet count and WCC- consistent with chronic inflammation, high CRP or ESR
What antibody tests may be +ve in RA and what should be -ve
CCP and RF +ve, ANA -ve
What causes anaemia in RA
IL-8 from jts trigger hepcidin release from liver and forces BM to hold on to iron that is normally scavenged from RBCs
What Ix could be done in RA
Mainly blood tests, test for CCP and RF
Coeliac screen to rule out, test viral titres as of HIV, HEP B/C, RUbella which are all assoc with arthritis.
X-ray of severe disease will show erosions
What is used to monitor disease activity in RA
DAS 28 - counts tender joints and swollen joints, VAS 1-100 and ESR or CRP
What is early treatment of RA
Short course oral steroids (pred) tapered over 12 weeks + DMARD
Pro-inflammmatory RA cytokines
TNFa, IL-1 and IL-6
