4. Rheumatoid arthritis Flashcards
Define rheumatoid arthritis
Chronic
Autoimmune
Symmetrical
Synovitis
Why does back pain not present in rheumatoid arthritis?
It is a SYNOVIAL joint problem
Which joints are most commonly affected in rheumatoid arthritis?
MCP PIP MTP wrist knees ankles
Give 2 examples of joint deformity caused by rheumatoid arthritis
Swan-neck (hyperextension at PIP)
Boutonniere (hyperflexion at PIP)
What is rheumatoid factor?
MAY be present in blood with RA
= IgM auto-Ab against IgG
Recall 3 clinical features of RA
Chronic arthritis:
- Polyarthritis - swelling of the small joints of the hand and wrists is common
- Symmetrical
- Early morning stiffness in and around joints (stiff joints in the morning and take a long time to warm up)
- May lead to joint damage and destruction - - ‘joint erosions’ on radiographs
Extra-articular disease can occur:
- Rheumatoid nodules
- fever, malaise etc driven by TNF alpha
- Rheumatoid ‘factor’ may be detected in blood
Recall the key radiological finding in extensive rheumatoid arthritis
Joint space narrows due to loss of cartilage
What does Anti-CCP stand for?
Anti-cyclic citrullinated peptide
What is citrullination?
Post-translational modification of arginine to citrulline associated with inflammation
What is the most common extra-articular manifestation of rheumatoid arthritis and what causes it?
rheumatoid nodules= Necrotic area surrounded by macrophages
Caused by RF complexes
What causes malaise in rheumatoid arthritis?
Abnormal clutches of cytokines (particularly TNF)
What is a novel effective treatment for the systemic features of rheumatoid arthritis?
Anti-TNF
What are the 3 main approaches to rheumatoid arthritis management?
- Stop smoking
- DMARD - methotrexate to reduce inflammation
- Biologics like anti-TNF
Recall 2 groups of people for whom anti-TNF is contra-indicated
- Hep B - could re-activate latent virus
2. TB patients- as TNF key to fighting TB by granuloma formation
