Autoimmune Inflammatory Arthritis Flashcards
What are the main types of inflammatory arthritis?
P - Psoriatic Arthritis
A - Ankylosing Spondylitis
I - IBD
R - Reactive Arthritis
+
Gout
=> All have HLA-B27 association
What is Rheumatoid Arthritis?
- Systemic Inflammatory Disease
- Characterised by symmetrical, deforming peripheral polyarthritis
What are the risk factors of Rheumatoid Arthritis?
- Smoking
- Family History
- Pre menopausal women
- Gender (female)
What are the clinical features of Rheumatoid Arthritis?
- Symmetrical, painful and swollen joints in hands
- Early morning stiffness
- Recurrent soft tissue problems
- Deformities in hands
- Rheumatoid nodules
- Extra-articular manifestations
What are the different types of deformities seen in the hands of those with Rheumatoid Arthritis?
=> Ulnar deviation
=> Swan neck Deformity
- PIP in hyperflexion
- DIP is bent
=> Boutonniere Deformity
- PIP in flexion
- DIP is hyperextension
What is the diagnostic criteria for Rheumatoid Arthritis?
=> Joint involvement 1 large joint - 0 2-10 large joints - 1 1-3 small joints - 2 4-10 small joints - 3 > 10 small joints - 5
=> Serology
-ve RF and -ve anti-CCP - 0
Low +ve RF or low +ve anti-CCP - 2
High +ve RF or High +ve anti-CCP - 3
=> Acute Phase Reactants
Normal CRP and Normal ESR - 0
Abnormal CRP or Abnormal ESR - 1
=> Duration of symptoms
< 6 weeks - 0
≥ 6 weeks - 1
=> Scores ≥ 6 are diagnostic
What are the investigations in suspected Rheumatoid Arthritis?
=> Bloods - ESR and CRP
At least one is raised
=> Serum antibodies - RF and anti-CCP
Both can be raised, but anti-CCP is more specific to RA and must be raised to diagnose RA
=> X rays
Early X ray findings - loss of joint space, juxta-articular osteoperosis and soft tissue swelling
Late X ray findings - peri-articular erosions and sublaxation
What is the management of Rheumatoid Arthritis?
RA is incurable, treatments aim to reduce pain and symptoms
=> Drugs used:
- DMARDS (monitor FBC and LFTS with these drugs as there is an increased risk of myelosuppression)
- Corticosteroids
- NSAIDs
- TNF-a inhibitors (do CXR before prescribing to look for signs of TB)
- Rituximab
=> Steps in management:
- Initially started on DMARD monotherapy with intermittent corticosteroids. CRP monitored to asses treatment response
- TNF-a inhibitors only used when 2 DMARDs have failed, including methotrexate
- Rituximab. 2 IV infusions given 2 weeks apart
What are some examples of DMARDs?
- Methotrexate
- Sulfasalazine
- Leflunomide
- Hydroxychloroquine
What are some examples of TNF-a inhibitors?
=> Entanercept - acts as a decoy receptor
=> Infliximad - binds to TNF-a to prevent binding to receptor
=> Adalimumab
=> Before starting TNF-a inhibitors, a CXR should be done, as these drugs can lead to reactivation of latent TB
What is Psoriatic Arthritis?
- Chronic inflammatory joint disease associated with psoriasis
Distinguished from Rheumatoid Arthritis through:
- Presence of dactylitis
- Absence of anti-CCP antibodies
What is dactylitis?
Fusiform swelling of an entire digit
=> Causes of dactylitis:
- Psoriatic and Reactive Arthritis
- Sickle cell disease
- Other rarer causes: sarcoidosis, tuberculosis, syphilis
What are the risk factors of Psoriatic Arthritis?
- Psoriasis
- Family history of psoriasis
- History of joint or tendon trauma
- HIV
What are the clinical features of Psoriatic Arthritis?
- Psoriasis
- Dactylitis
- Joint pain and stiffness
- Spinal stiffness - reduction in cervical spine motility
What are the investigations in suspected Psoriatic Arthritis?
=> X Rays
- Erosive changes with pencil and cup deformities
=> Serum antibodies - RF and anti-CCP
- RF not elevated
- Anti-CCP -ve
=> Bloods - ESR, CRP
Not raised despite inflammatory condition
