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4: Y4 - Rheumatology [19] > [9] Rheumatoid Arthritis > Flashcards

[9] Rheumatoid Arthritis Flashcards

1
Q

What is RA?

A

Rheumatoid arthritis is a chronic, systemic inflammatory disease, characterised by symmetrical, deforming, peripheral polyarthritis

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2
Q

What does RA cause?

A

Pain, swelling, and stiffness in the joints

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3
Q

How do the symptoms of RA vary?

A

There may be periods where the symptoms become worse, known as flare-ups

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4
Q

What causes RA?

A

The cause is unclear, however it is believed to be a combination of genetic and environmental factors

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5
Q

What does the underlying mechanism of RA involve?

A

The bodies immune system attacking the joints, resulting in inflammation and thickening of the joint capsule, as well as the underlying bone and cartilage

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6
Q

What are the risk factors for RA?

A

Family history
Smoking
Silica exposure
Female gender

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7
Q

What are the main symptoms of RA?

A

Joint pain, swelling, and stiffness

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8
Q

What joints are affected in RA?

A

It can affect any joint in the body, however small joints are often the first to be affected

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9
Q

Does RA affect joints symmetrically?

A

It typically does, however this isn’t always the case

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10
Q

How quickly do symptoms develop in RA?

A

They often develop gradually over several weeks, but in some cases can progress quickly over a number of days

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11
Q

Describe the pain associated with RA?

A

It is usually a throbbing and aching pain

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12
Q

When is the pain in RA worse?

A

Often in the morning and after a period of inactivity

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13
Q

What systemic symptoms may be present in RA?

A 
Fatigue
Fever
Sweating
Loss of appetite
Weight loss
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14
Q

What can the inflammation associated with RA cause in other areas of the body?

A

Dry eyes

Chest pain

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15
Q

What investigations should be done in RA?

A 
Examination
Blood tests
CXR
Ultrasound
MRI
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16
Q

What examination findings may be present in early RA?

A

Swollen MCP, PIP, wrist, or MTP joints
Tenosynovitis
Bursitis

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17
Q

What examination findings may be present in later RA?

A

Ulnar deviation
Subluxation of wrist and fingers
Swan-deck deformity of fingers, or Z-deformity of thumbs
Rupture of hand extensor tendons

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18
Q

What can be looked for on blood tests in RA?

A

Rheumatoid factor

Anti-cyclic citrullinated antibodies (Anti-CCP)

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19
Q

What % of cases of RA have positive rheumatoid factor?

A

70%

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20
Q

What is high amounts of RhF associated with in RA?

A

Severe disease
Erosions
Extra-articular disease

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21
Q

What is good about measuring anti-cyclic titrated antibodies in RA?

A

They are highly specific for RA with a reasonable sensitivity

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22
Q

What can anti-cyclic titrated antibodies be used for in RA?

A

Predict disease progression

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23
Q

What else may be found on blood tests in RA?

A

Anaemia of chronic disease
Increased platelets
Increased ESR
Increased CRP

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24
Q

What may be found on x-ray in RA?

A 
Soft tissue swelling
Juxta-articular osteopenia
Decreased joint space
Bone erosions
Subluxation
Complete carpal destruction
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25
Q

What is the advantage of ultrasound and MRI in RA?

A

They can detect synovitis more accurately than x-ray, and have a greater sensitivity in detecting bone erosions

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26
Q

What are the parameters in the diagnostic criteria of RA?

A

Joint involvement
Serology
Acute phase reactants
Duration of symptoms

27
Q

What score is diagnostic in RA?

A

Over 6

28
Q

How is ‘joint involvement’ scored in the diagnostic criteria for RA?

A

1 large joint = 0 ; 2-10 large joints = 1
1-3 small joints = 2
4-10 small joints = 3
>10 joints (at least 1 small joint) = 5

29
Q

How is ‘serology’ scored in the diagnostic criteria for RA?

A

Negative RF and negative anti-CCP = 0
Low +ve RF, or low +ve anti-CCP = 2
Higher +ve RF, or high +ve anti-CCP = 3

30
Q

How is ‘acute phase reactants’ scored in the diagnostic criteria for RA?

A

Normal CRP and ESR = 0

Abnormal CRP or abnormal ESR = 1

31
Q

How is ‘duration of symptoms’ scored in the diagnostic criteria for RA?

A

<6 weeks = 0

>6 weeks = 1

32
Q

What is involved in the management of RA?

A 
Medication
Pain relief 
Physiotherapy
Occupational therapy
Surgery
33
Q

What medication is used in the management of RA?

A

Disease-modifying anti-rheumatic drugs (DMARDs)
Biological treatments
Jak inhibitors

34
Q

Give 2 examples of DMARDs

A

Methotrexate

Sulfasalazine

35
Q

Give 3 examples of biological treatments used in RA

A

Infliximab
Rituximab
Adalimumab

36
Q

Give 2 examples of Jak inhibitors used in RA

A

Tofacitiib

Baricitinib

37
Q

What may be used for pain relief in RA?

A

Painkillers such as paracetamol and codeine
NSAIDs
Corticosteroids

38
Q

What is the purpose of physiotherapy in RA?

A

Improve fitness and muscle strength
Make joints more flexible
Help with pain relief

39
Q

How can physiotherapy help with pain in RA?

A

Heat or ice packs

Transcutaneous electrical nerve stimulation (TENS)

40
Q

How does a TENS machine work?

A

It applies a small pulse of electricity to the affected joint, which numbs the nerve endings and can help ease the pain of RA

41
Q

When can occupational therapy be helpful in RA?

A

When RA affects a patients performance of everyday tasks

42
Q

How can OT help in RA?

A

They can provide training and advice that will help protect the joints, both at home and at work

43
Q

What devices/other stuff might OT recommend?

A

Some type of support for the joint, e.g. splints

Devices that can help open jars or turn on taps

44
Q

What are the surgical options in the management of RA?

A

Arthroscopy
Joint replacement
Finger, hand, and wrist surgery

45
Q

What finger, hand, and wrist surgery may be done in RA?

A

Carpal tunnel release
Release of tendons in the fingers to treat abnormal bending
Removal of inflamed tissue lining the finger joints

46
Q

What is arthroscopy?

A

A procedure to remove inflamed joint tissue

47
Q

How is an arthroscopy performed?

A

An arthroscope is inserted into the joint through a small incision to visualise the joint, then surgical instruments are inserted through other small incisions to remove damaged tissue

48
Q

What is an arthroscope?

A

A thin tube with a light source and camera

49
Q

What are the options for joint replacement in RA?

A

Partial or complete replacement of hip, knee, or shoulder

50
Q

What is the down side of joint replacement in RA?

A

It is a major operation, which involves a several day inpatient stay and months of rehab
Joint replacements have limited lifespan
Do not restore all functions of damaged joints

51
Q

What is the lifespan of a joint replacement?

A

10-20 years

52
Q

What are the potential complications of RA?

A 
Carpal tunnel syndrome
Widespread inflammation, affecting lungs, heart, eyes, and blood vessels
Joint damage
Cardiovascular disease
Cervical myelopathy
53
Q

What can inflammation in the lungs or pleura caused by RA lead to?

A

Pleurisy or pulmonary fibrosis, leading to chest pain, a persistent cough, and shortness of breath

54
Q

What can inflammation around the tissue of the heart caused by RA lead to?

A

Pericarditis, which causes chest pain

55
Q

What can inflammation around the eyes caused by RA lead to?

A

Scleritis

Sjorgen’s syndrome

56
Q

What is inflammation of the blood vessels caused by RA a form of?

A

Vasculitis

57
Q

What can inflammation of the blood vessels caused by RA lead to?

A

Thickening, weakening, narrowing, and scarring of the blood vessel walls

58
Q

What can inflammation of the blood vessels caused by RA lead to in severe cases?

A

Can affect blood flow to organs and tissues, and can be life threatening

59
Q

What can happen if RA is treated early, or isn’t well controlled?

A

The inflammation in the joints could lead to significant and permanent damage

60
Q

What significant and permanent damage can occur in RA?

A

Damage to nearby bone and cartilage
Damage to nearby tendons
Joint deformities

61
Q

What are patients who have had RA for a long time at increased risk of?

A

Cervical myelopathy

62
Q

What is cervical myelopathy?

A

A condition caused by dislocation of the joints at the top of the spine, which puts pressure on the spinal cord

63
Q

What is the clinical importance of cervical myelopathy?

A

It is a serious condition that can greatly affect mobility and can lead to permanent spinal cord damage if not promptly treated with surgery

4: Y4 - Rheumatology [19] (10 decks)

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