L05: Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis

A

Inflammation of the synovial joint

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2
Q

What joints are involved in rheumatoid arthritis

A

Small joints

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3
Q

Does rheumatoid arthritis prevent symmetrically or unsymmetrical

A

Symmetrical

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4
Q

What are the symptoms of ra

A

Pain
Swelling
Stiffness

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5
Q

When does the stiffness in ra present

A

Morning for an hour and stiffness with rest

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6
Q

What are the other deformities of ra

A
MCP joint subluxation
Ulnar deviation
Boutonnière deformity 
Swan neck deformity
Z thumb
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7
Q

What can happen if the inflammation in the synovial joint spills out of the joints

A

Extra-articular damage to cause osteoporosis

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8
Q

What are the differential diagnosis for rheumatoid arthritis

A

Psoriatic arthritis
SLE
Post viral arthritis

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9
Q

What blood tests can be done to investigate RA

A

Inflammatory markers: CRP, ESR

Autoantibodies: rheumatoid factors, anti CCP antibody (highly specific for RA)

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10
Q

What imaging can be used to investigate ra

A

Plain radiographs

Ultrasound/mri

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11
Q

What classification criteria is used for ra and how many points are needed for diagnosis

A

At least 6 points

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12
Q

How is ra managed

A

Pain: Analgesic, NSAIDs
Stop smoking
Physiotherapy
Occupational therapy

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13
Q

What is the main drug given to people with ra

A

Methotrexate (main drug but is teratogenic)
Hydrocychloroquine (alternative for mild disease)
Short term glucocorticoid up to 3 months

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14
Q

Which cells are involved in driving the inflammation in RA

A
T cells
B cells
Neutrophils
Macrophages
Osteoclasts
Fibroblasts
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15
Q

Which cytokines activate immune cells

A

TNF alpha

Interleukin 6

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16
Q

Where do cytokines bind to on the immune cells

17
Q

How can we have a targeted treatment against ra

A

By targeting cytokines are blocking the receptor so the cytokines cant bind

18
Q

Give examples of treatment that works to bind to TNF alpha

A

Adalimumab
Certrolizumab
Golimumab
Infliximab

These are monoclonal antibodies

19
Q

Name a drug that binds to TNF alpha receptors to stop TNF alpha from binding

A

Etanercept

20
Q

Name a drug that binds to IL6 receptor to stop il6 from binding

A

Tocizilzumab

Sarilumab

21
Q

How can we target B cells

A

By targeting cd20 on B cells

22
Q

Which drug can bind to cd20 on B cells

23
Q

How can we target T cells

A

By blocking cd28 on t cell

24
Q

Name a drug that binds to cd28 on T cell

25
When cytokines bind to its receptors which pathway becomes activated
JAK pathway
26
When Jak protein is activated what does it go onto activate
Stat
27
What drugs can be used in ra to target the Jak pathway
Tofacitninb | Baricitinib
28
When patients are in remission how do we manage them
Step down the therapy by: Considering glucocorticoid withdrawal Biological synthetics DMARD
29
When are tnf alpha inhibitors considered for use
When the patient is not responding to at least 2 DMARDs (methotrexate, leflunomide, sulfasalazine, hydroxycholoroquine)