Clinical Aspects of Rheumatoid Arthritis

Question 1

What is the definition of rheumatoid arthritis?

Answer 1

Rheumatoid Arthritis is a chronic auto immune systemic illness characterised by a symmetrical peripheral arthritis and other systemic features

Question 2

What may rheumatoid arthritis be associated with?

Answer 2

• Joint damage
• Disability
• Premature mortality

Question 3

What is the ARA criteria for rheumatoid arthritis?

Answer 3

• Morning stiffness
• Arthritis of 3 or more joint areas
• Arthritis of hand joints
• Symmetric arthritis
• Rheumatoid nodules
• Serum rheumatoid factor
• Radiographic changes

Question 4

What is the prevalence and incidence of RA?

Answer 4

Prevalence
-Approx 1% of population

Incidence
-Approx 200 ne cases per year in Grampian

Question 5

Who gets RA?

Answer 5

• F:M 3:1

- Peak age of onset in 4th/5th decase but may occur at any age from 16 years

Question 6

What is the aetiology of RA?

Answer 6

Genetics

• Link with siblings in particular monozygotic twins
• Genetic contribution estimated to be 50-60%
• Closest association with specific amino acid sequences at positions 70-74 of DRB1 (sheared epitope)

Environment

• Cigarette smoking
• Chronic infection e.g periodontal disease

Question 7

What is the pathogenesis of RA?

Answer 7

Cartilage thinning

Inflamed synovial membrane

Pannus (abnormal layer of fibrovascular/ granulation tissue)

• Major cell types: T lymphocytes and macrophages
• Minor cell types: fibroblasts, plasma cells, endothelium dendritic cells

Synovial fluid
-Major cell type: neutrophils

Question 8

How is RA investigated?

Answer 8

Immunology

• Rheumatoid factor (IgG, IgM)
• Anti Cyclic Citrullinated Antibodies (anti CCP, ACPA)

Radiology

Question 9

What are the symptoms of RA?

Answer 9

• Pain
• Stiffness
• Immobility
• Poor function
• Systemic Symptoms

Question 10

What are the clinical signs of RA?

Answer 10

• Swelling
• Tenderness
• Limitation of movement
• Redness
• Heat

Question 11

What are the systemic features of RA?

Answer 11

Non-specific

• Fatigue/lassitude
• Weight loss
• Anaemia

Specific

• Eye problems
• Lung issues
• Nerve issues
• Skin problems
• Kidney problems

Long term

• CVS risk
• Malignancies

Question 12

How is RA assessed?

Answer 12

Disease activity score

• DAS<2.4 represents clinical remission
• DAS>5.1 represents eligibility for biologic therapy

Question 13

What are the outcomes of RA?

Answer 13

• 75% of cases diagnosed during working life
• Approx 33% will have stopped working within 2 years
• Approx 50% will be unable t0 work due to disability within 10 years of diagnosis
• A person with RA will have, on average 40 days sick leave/year (compared with 6.5)