Clinical Aspects of Rheumatoid Arthritis

Question 1

What percentage of the population is affected by rheumatoid arthritis?

Answer 1

1%

Question 2

What are the risk factors for rheumatoid arthritis?

Answer 2

Female sex (F:M 3:1)
Peak onset in 5th/6th decade
Genetic predisposition (main factor)
Environmental factors (smoking and chronic infection)

Question 3

What investigations can be useful in cases of rheumatoid arthritis?

Answer 3

Immunology for rheumatoid factor (IgG/IgM) or anti-cyclic citrullinated proteins (anti CCP/ ACPP)
X-ray to assess extent of damage and requirement of surgery
Ultrasound scan/Doppler to view inflammation

Question 4

What are the symptoms of rheumatoid arthritis?

Answer 4

• Pain
• Stiffness
• Immobility
• Poor function
• Systemic symptoms

Question 5

What are the signs of rheumatoid arthritis?

Answer 5

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

Question 6

What are the systemic features of rheumatoid arthritis?

Answer 6

• Fatigue
• Malaise
• Weight loss
• Anaemia
• Specific signs in eyes, lungs, nerves, skin, kidneys and CVS
• Malignancy

Question 7

What scoring system is used in rheumatoid arthritis and what scores are indicative of mild or severe disease?

Answer 7

DAS28 scoring system
DAS <2.4 indicates clinical remission
DAS >5.1 indicates need for biologic therapy

Question 8

Describe the outcome of rheumatoid arthritis

Answer 8

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)