L05: Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis
Inflammation of the synovial joint
What joints are involved in rheumatoid arthritis
Small joints
Does rheumatoid arthritis prevent symmetrically or unsymmetrical
Symmetrical
What are the symptoms of ra
Pain
Swelling
Stiffness
When does the stiffness in ra present
Morning for an hour and stiffness with rest
What are the other deformities of ra
MCP joint subluxation Ulnar deviation Boutonnière deformity Swan neck deformity Z thumb
What can happen if the inflammation in the synovial joint spills out of the joints
Extra-articular damage to cause osteoporosis
What are the differential diagnosis for rheumatoid arthritis
Psoriatic arthritis
SLE
Post viral arthritis
What blood tests can be done to investigate RA
Inflammatory markers: CRP, ESR
Autoantibodies: rheumatoid factors, anti CCP antibody (highly specific for RA)
What imaging can be used to investigate ra
Plain radiographs
Ultrasound/mri
What classification criteria is used for ra and how many points are needed for diagnosis
At least 6 points
How is ra managed
Pain: Analgesic, NSAIDs
Stop smoking
Physiotherapy
Occupational therapy
What is the main drug given to people with ra
Methotrexate (main drug but is teratogenic)
Hydrocychloroquine (alternative for mild disease)
Short term glucocorticoid up to 3 months
Which cells are involved in driving the inflammation in RA
T cells B cells Neutrophils Macrophages Osteoclasts Fibroblasts
Which cytokines activate immune cells
TNF alpha
Interleukin 6
Where do cytokines bind to on the immune cells
Receptors
How can we have a targeted treatment against ra
By targeting cytokines are blocking the receptor so the cytokines cant bind
Give examples of treatment that works to bind to TNF alpha
Adalimumab
Certrolizumab
Golimumab
Infliximab
These are monoclonal antibodies
Name a drug that binds to TNF alpha receptors to stop TNF alpha from binding
Etanercept
Name a drug that binds to IL6 receptor to stop il6 from binding
Tocizilzumab
Sarilumab
How can we target B cells
By targeting cd20 on B cells
Which drug can bind to cd20 on B cells
Rituximab
How can we target T cells
By blocking cd28 on t cell
Name a drug that binds to cd28 on T cell
Abatacept
When cytokines bind to its receptors which pathway becomes activated
JAK pathway
When Jak protein is activated what does it go onto activate
Stat
What drugs can be used in ra to target the Jak pathway
Tofacitninb
Baricitinib
When patients are in remission how do we manage them
Step down the therapy by:
Considering glucocorticoid withdrawal
Biological synthetics DMARD
When are tnf alpha inhibitors considered for use
When the patient is not responding to at least 2 DMARDs (methotrexate, leflunomide, sulfasalazine, hydroxycholoroquine)
