Inflammatory Arthritis: RA :)

Question 1

What is Rheumatoid Arthritis?

Answer 1

• Symmetrical, small joint inflammatory arthritis

unable to predict which cytokine is needed to be affected

inflammation affects cariltage = bone destruction

Question 2

Presentation of ra?

Answer 2

• Small joint involvement - MCP, PiP, MTP, wrist
• Gradually gets worst
• Has extra-articular features
• Palindomic RA (comes and goes), polymyalgic (systemically unwell with stifness), monoarthritis (first with one joint then progress)…etc

Question 3

What is a rheumatoid factor and is it good?

Answer 3

Occasionally, patients are tested to help diagnose juvenile rheumatoid arthritisor, more rarely, uveitis. Still, experts say HLA-B27 testing should generally be reserved for people whose symptoms strongly suggest AS. Having the gene doesn’t mean you’ll develop AS or a related disease.

80% of pt with positive Rheumatoid factor have RA!

Question 4

What is the managment for RA? drugs wise

Answer 4

• DMARDs - methotrexate, leflunomide, sulfasalazine, hydroxychloroquine
• Move to biologics if response to 2 DMARDs or more (inc. methotrexate) has proved inadequate
• Biologics - Anti-TNF, rituximab, abatacept, tocilizumab, JAK inhibitors

Question 5

epidemiology FOR ra?

Answer 5

-before menopause RA is 3 times more common in women than men, after menopause -RA onset → 20-40 yrs -smoking, infections, diet and hormonal are environmental factors

Question 6

pathophysiology for RA?

Answer 6

• cause RA not understood. -genetically susceptible ie exposed to unknown antigen resulting in self stimulation of immune system (auto-immunity) - immune response reacts with synovial membrane = inflammation + leads to cartilage damage and bone destruction -T cells seem to affect most → stimulate immune system via inflammatory cytokines

Question 7

investigation FOR RA?

Answer 7

Taking history asking how long pt has stiffness for + when in the day/upon which activities -Full blood count done(expect increased platelets count ), renal and liver function test, X-ray of chest and hands, MRI done to identify synovitis early, ultrasound for joint effusion+baker’s cysts

Question 8

managment for ra?

Answer 8

aim for RA is to reduce/slow joint inflammation: -early use of disease-modifying antirheumatic drugs +biological agents (treatment should start 3 months before onset) -refer to rheumatologist in order to prevent destruction of joints: small joints of hands and feet are affected, more than one joint affected -non medical management = core stability exercise, aerobic activities

Question 9

RA VS OA

Answer 9

• RA present symmetrically whereas OA is asymmetrical
• RA morning stiffness >1hr, OA < 30 mins
• OA is worse on movement RA is not
• common age of onset for RA = 20-40 yrs, >50 for OA
• RA onset is usually rapid (Weeks to months), OA is usually years
• RA present with systemic symptoms, OA doesn’t
• RA is worse in morning, OA is worse on activities

Question 10

What is seen on an xray for ra?

Answer 10

• SOFT tissue swelling
• osetopenia
• errosions
• effusion

Question 11

what can be issues with methotrexate?

Answer 11

2 drug interactions: Trimethoprim (antibiotic to treat UTI - with methotreaxte would wipe out bone marrow and WBC) and azophiaprin????? (ANOTHER DRUG THAT SOUNDS LIKE IT?!- causes wipe out of WBC too)

Question 12

first biologic given with RA?

Answer 12

addalimamab - first line biologic that is given for RA first - given fortnightly

weakness - activation of TB - so have to screen for possible TB