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5. Inflammatory arthritis > Discuss the basic epidemiology, presentation, investigation, management, complications and prognosis of rheumatoid arthritis > Flashcards

Discuss the basic epidemiology, presentation, investigation, management, complications and prognosis of rheumatoid arthritis Flashcards

1
Q

Which deformity is characterised by MCP flexion, PIP hyperextension and DIP flexion?

A

Swan neck deformity

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2
Q

Which human leucocyte antigen (HLA) gene is associated with rheumatoid arthritis?

A

HLA-DRB1

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3
Q

What produces rheumatoid factor antibodies and anticitrullinated protein antibodies and where are they produced?

A

They are produced by activated B-cells in the synovium

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4
Q

What joints are affected by rheumatoid arthritis?

A
  1. shoulders
  2. elbows
  3. wrist
  4. MCP joints
  5. PIP joints
  6. knees
  7. ankles
  8. MTP joint
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5
Q

What is the Norfolk Arthritis Register?

A

A primary care based inception cohort of patients with inflammatory arthritis

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6
Q

What is the classification criteria for RA?

A

At least 4 of the following for 6 weeks:

  • Morning stiffness > 1 hour
  • Arthritis of > 3 joint areas
  • Symmetry
  • Nodules
    Radiographic erosions
  • Rheumatoid factor positive
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7
Q

How does synovitis present upon examination?

A
  • “boggy” joint swelling (similar consistency to a grape)
  • the skin is usually warm and red (due to increased blood flow)
  • swelling is tender to palpate
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8
Q

What are Boutonniere and swan-neck deformities of the digits due to?

A

PIP synovitis and laxity and/or contraction of the extensor and flexor tendons

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9
Q

What are the 4 main radiological signs of rheumatoid arthritis?

A
  1. soft tissue swelling
  2. periarticular osteoporosis
  3. juxta-articular erosions
  4. narrowing of joint space
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10
Q

Name 3 categories assessed by the HAQ disability index

A
  1. dressing and grooming
  2. reach and grip
  3. walking
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11
Q

What is the pathological process behind synovitis in rheumatoid arthritis?

A
  1. inflammatory cells infiltrate the synovium and proliferate
  2. macrophages and osteoclasts create a layer of chronically inflamed tissue (pannus) which extends from the joint margins and erodes the articular cartilage
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12
Q

True or false?

Rheumatoid arthritis affects men more than it affects women?

A

False

woman > men

2:1

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13
Q

What are ligament insertions (entheses) a common site of in RA?

A

inflammation

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14
Q

Which deformity is this?

A

Swan neck

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15
Q

Which deformity is characterised by PIP flexion with DIP hyperextension?

A

Boutonniere

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16
Q

True or false?

rheumatoid arthritis of the ankles are included in the DAS-28 score

A

False

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17
Q

How can immunisation cause RA in some patients?

A

the patient has an abnormal immune system and the immunisation has acted as a trigger

18
Q

What are 4 extraarticular features of RA?

A
  1. rheumatoid nodules
  2. tenosynovitis
  3. bursitis
  4. carpal tunnel syndrome
19
Q

Which deformity is this?

A

Boutonniere

20
Q

Describe the Health Assessment Questionnaire (HAQ)

A

Total score can range from 0-3.0

higher scores indicate worse function

and greater disability

21
Q

What are 4 systemic complications of RA?

A
  1. feeling systemically unwell
  2. anaemia
  3. felty syndrome
  4. rheumatoid lung disease
22
Q

What is the societal impact of RA?

A
  • within 3 years of diagnosis, 25% of patients are no longer working
  • personal loss of income
  • government loss of taxation
  • drug costs
23
Q

What are 3 predictors of a poor prognosis?

A
  1. RF/Anti-CCP
  2. Nodules
  3. HAQ score
24
Q

The DAS-28 (disease activity score) is a statistically derived index using:

A
  1. Tender joint score
  2. Swollen joint score
  3. ESR
  4. General health assessment
25
Q

What is most commonly affected by tenosynovitis in rheumatoid arthritis?

A

the flexor tendons of the fingers

26
Q

What is the pathological process behind joint deformity in rheumatoid arthritis?

A
  1. Macrophages and osteoclasts create a layer of chronically inflamed tissue, pannus,
  2. which extends from the joint margins and erodes the articular cartilage
  3. extensive erosions of cartilage and bone lead to joint deformity
27
Q

What are 5 risk factors for developing rheumatoid arthritis?

A
  1. cigarette smoking
  2. obesity
  3. immunisation
  4. blood transfusion
  5. previous termination of pregnancy
28
Q

What joints in the hand are spared by rheumatoid arthritis?

A

DIPs

29
Q

Is rheumatoid arthritis symmetrical or assymetrical?

A

symmetrical

30
Q

What does a positive rheumatoid factor in patients with rheumatoid arthritis?

A

a higher rate of systemic disease and poorer prognosis

31
Q

What can inflammation of the MCP joints cause?

A

Ulnar deviation

32
Q

True or false?

Rheumatoid factor and anti-CCP are specific for rheumatoid arthritis?

A

False

Only anti-ccp is

33
Q

What may a full blood count reveal about a patient with rheumatoid arthrits?

A
  • anaemia due to chronic inflammation/disease
  • thrombocytosis due to chronic inflammation
  • CRP/ESR raised
34
Q

What are 2 surgical treatments available for RA?

A
  1. arthroplasty
  2. synovectomy
35
Q

What is rheumatoid arthritis?

A

an autoimmune inflammatory condition characterised by a symmetrical polyarthritis

36
Q

True or false?

RA affects mainly small and medium sized joints in a symmetrical fashion

A

True

37
Q

What imaging technique can be used to detect synovitis in early rheumatoid arthritis?

A

ultrasound

38
Q

What are rheumatoid nodules?

A
  • firm subcutaneous nodules
  • which develop in areas affected by pressure or friction
39
Q

What causes the thickened joint capsule to extend in RA?

A

effusion

40
Q

What immunological cells play a key role in initiating inflammation in rheumatoid arthritis? (3)

A
  1. T-lymphocytes
  2. B-cells
  3. activated macrophages

5. Inflammatory arthritis (2 decks)

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