Inflammatory arthiritis - intro, just notes

Question 1

5 different conditions rheumatology treats

Answer 1

• Inflammatory conditions
• Connective tissue diseases
• Osteoporosis
• Metabolic bone problems - osteoporosis if not treated by GP
• Pain syndromes

Question 2

Types of arthiritis

Answer 2

• OA
• Rheumatoid
• Septic
• Ankylosing spondylitis

Question 3

Inflammatory/RA history

Answer 3

• Worse morning?
• How long stiffnesss?
• Which joints? - if symmetrical suggests RA, also small joints?, gout is often 1 joint, OA often weight bearing
• Pain in day?
• Nodules?
• Improve with exercise?
• FH - genetic?
• Smoking/alcohol?
• Skin rash, back pain?
• How is disease affecting you?
• Neck swelling - arthitiris can be brought on by lymphoma
• HepB/C/HIV - RA?
• Weight loss? Night sweats?
• Trauma?

Question 4

Examination findings for RA

Answer 4

• Boggy joint - fluctuations of fluid at joint
• Swelling
• Swan neck deformity
• Boutonierre deformity
• Z thumb - under and outwards
• Ulnar deviation
• Nodules?
• ROM?

Question 5

What happens to uric acid in gout?

Answer 5

Decreases as it forms crystals

Question 6

Autoantibodies in blood for RA

Answer 6

• Anti cyclic citrullinated peptide (anti CCP)
• Rheumatoid factor

Question 7

Management for RA

Answer 7

• DMARDs - eg methotrexate
• Short course steroids in meantime as takes 6-8 weeeks to work
• Physiotherapy/OT
• Psychologist
• Specialist nurse

Question 8

What score is used to assess RA?

Answer 8

DAS28 score - assess severity and monitor until into remission

Question 9

Other options for drugs for RA

Answer 9

Leflunomide - commonly combined with MTX
Hydroxychloroquine - need regular eye testing as causes retinopathy

Question 10

Final option for RA management

Answer 10

Biologics - if 2x failed DMARDs
eg anti TNF alpha, or Rituximab anti CD20

Question 11

What happens if you get infection while on immunosupressant drugs?

Answer 11

• Stop drugs
• resume 1 week after recovered

Question 12

Scoring system used to assess how likely RA is

Answer 12

ACR-EULAR scoring system

Question 13

Scoring subjects in ACR-EULAR

Answer 13

If score 6 or more out of 10 - likely RA
* Joint involvement
* Serology
* Acute phase reactants
* Duration

Question 14

Joint involvement score

Answer 14

• 1 large - 0
• 2-10 large - 1
• 1-3 small +/-large - 3
• > 10 joints (at least one small) -5

Question 15

Serology scoring

Answer 15

• Negative RF, negative anti CCP - 0
• Low positive RF or anti CCP - 2
• High +ve RF or anti CCP - 3

Question 16

Acute phase reactants scoring

Answer 16

• Normal CRP and ESR - 0
• Abnormal CRP or ESR - 1

Question 17

Duration scoring

Answer 17

• Less than 6 weeks - 0
• 6 weeks or more - 1