Inflammatory Autoimmune Seropositive Arthritis

Question 1

Outline the epidemiology of rheumatoid arthritis (RA).

Answer 1

• Global prevalence data suggest a similar trend regarding the sex-specific burden of disease

Question 2

What are the risk factors of rheumatoid arthritis (RA) (1)?

Answer 2

• Genetic predisposition

Question 3

Outline the pathogenesis of rheumatoid arthritis (RA).

Answer 3

The aetiology of RA is unknown. Some studies have, however, pointed to possible causative factors:
* Genetics
* Infection

Question 4

Outline the pathophysiology of rheumatoid arthritis (RA).

Answer 4

• Inflamed synovium is central to the pathogenesis
• This very inflammatory setting, when not treated, leads to the eventual destruction of the involved joint

The synovium shows increased angiogenesis, cellular hyperplasia, influx of inflammatory cells, changes in the expression of cell surface adhesion molecules, and many cytokines
The synovial lining becomes hyperplastic, with infiltration of the sublining with mononuclear cells including T cells, B cells, macrophages, and plasma cells
This formation of locally invasive synovial tissue is characteristic and it is involved in causing the erosions seen in RA

Question 5

How would a patient with rheumatoid arthritis (RA) present (5)?

Answer 5

• Active symmetrical arthritis lasting > 6 weeks
• Age 50 to 55 years
• Female sex
• Joint pain
• Joint swelling

Question 6

What investigations are suggested in suspected rheumatoid arthritis (RA) (4)?

Answer 6

• Rheumatoid factor (RF)
• Anti-cyclic citrullinated peptide (anti-CCP) antibody
• X-Ray
• USS

Question 7

What would a rheumatoid factor (RF) test show in a patient with rheumatoid arthritis (RA)?

Answer 7

• Positive

Question 8

What would an X-Ray show in a patient with rheumatoid arthritis (RA)?

Answer 8

• Erosions

Question 9

What would an USS show in a patient with rheumatoid arthritis (RA)?

Answer 9

• Synovitis of the wrist and fingers

Question 10

What is the treatment of acute rheumatoid arthritis (RA) (1^st line 1 / Consider 2)?

Answer 10

1^st line:
* Conventional synthetic disease-modifying anti-rheumatic drug (DMARD)

Consider:
* Corticosteroid
* Non-steroidal anti-inflammatory drug (NSAID)

In sever cases can use:
* Biological agent or targeted synthetic DMARD

Question 11

What is the treatment of ongoing rheumatoid arthritis (RA) (1^st line 1 / Plus 1 / Consider 2)?

Answer 11

1^st line:
* Methotrexate

Plus:
* Biological agent or disease-modifying anti-rheumatic drug (DMARD)

Consider:
* Corticosteroid
* Non-steroidal anti-inflammatory drug (NSAID)

In sever cases can use:
* Biological agent or targeted synthetic DMARD

Question 12

What are the current biological therapies available for RA?

Answer 12

• Anti-TNF e.g. infliximab
• B cell depletion e.g. rituximab
• Modulation of T cell co-stimulation e.g. abatacept
• Inhibition of IL-6