INFLAMMATORY DISEASES (CLINICALS) Flashcards

1
Q

What are the signs and symptoms of RA?

A

Pain, swelling, stiffness (especially upon waking and can last for more than 30 minutes), fever, weight loss, redness and joint warmth.

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2
Q

What are the tests done to diagnose RA?

A

Blood tests;
- Erythrocyte sedimentation rate (ESR) and CRP
- Rheumatoid factor: 30% of RA patients do not have this.
- Antinuclear antibody (ANA): 40% of patients have it.
- Anti-cyclic citrullinated peptide: specific for RA
- Radiology; you see the inflammation but when it is early stage that may not be seen.

On examination; you can squeeze the hand slightly and if there is a sign of gel or sometimes pain then it is characteristic of RA.

According to the NICE guidelines for investigations and diagnosis of RA, offer to carry out a blood test for rheumatoid factor in adults with suspected RA who are found to have synovitis on clinical examination. Consider measuring the anti-CCP antibodies in adults with suspected RA but test negative for rheumatoid factor. X-rays the hands and feet in adults with suspected RA and persistent synovitis.

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3
Q

What are the important factors to consider when diagnosing RA?

A

No one test will provide a diagnosis. it is dependent on complete history taking, clinical presentation and investigations.
-During history taking: ask about morning stiffness and mostly the morning stiffness is greater than 30 minutes, family history and lifestyle.
- Investigations: check for inflammatory markers, haematological parameters, immunological parameter and radiological investigations.
- Clinical presentations: symmetrical effects on synovial joints as symptoms discussed.

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4
Q

What are the monitoring for RA?

A
  • DAS 28 with scores > 5.1 showing high activity disease, < 3.2 showing low activity disease, < 2.6 being remission.

Appropriate management of early therapy shows
- improvement in symptoms
- Reduce mortality
- Improves function
- May reduce comorbidities

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5
Q

What are the aims of treatment in RA?

A
  • Minimising joint pain and swelling
  • Preventing deformity and radiological damage (ie erosion)
  • Maintaining quality of life
  • Controlling extra-articular manifestations.
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6
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