Medicine Flashcards
Rheumatoid Arthritis definition
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder which primarily affects joints that are lined with synovium . It is typically characterized by a symmetrical , occasionally deforming , peripheral polyarthritis . Because it is a systemic disease , it can also affect the whole body, including the heart, lungs and eyes.
Explain the pathophysiology of joint destruction in rheumatoid arthritis
Autoimmune attack on synovial membrane
Synovitis
Infiltration of immune cells + synovial hypertrophy = pannus
Pannus destroys and erodes articular cartilage
Symptoms of RA
Stiffness >1 hour Symmetrical joint pain Swollen joints Deformities - boutonnières, swann, ulnar deviation Rapid onset
Fatigue, malaise, anorexia, low-grade fever, anaemia of chronic disease
Extra-articular manifestations of rheumatoid arthritis
Scleritis Vasculitis Pulmonary fibrosis Renal damage due to drugs Stomach ulcers due to NSAIDS
You suspect RA, what Ix.
CRP ESR
FBC - anaemia, thrombocytosis, mild leukocytosis
Rheumatoid factor (sensitive but not specific) + Anti-CCP (specific but not sensitive)
KFTs and LFTs to see if they can cope with ttmt
X-ray
Differential tests
Ca - pseudogout
Uric acid - gout
ANCA - vasculitis
Ttmt for RA
TREAT WITHIN 3 MONTHS OF SYMPTOMS
DMARDS - Methotrexate, Sulfasalazine, Leflunomide
+ steroids (PO Prednisilone) for flare-ups
+/- NSAIDs
Indications for dialysis
A - metabolic acidosis E - electrolyte imbalance I - intoxication O - overload of fluids U - uraemia (encephalopathy, pericardial rub, confusion)
Complication of a distal wrist #
Rupture of EPL
Addisonian crisis ttmt
Can be because steroid withdrawal (or infection and didn’t up dose)
Need to correct
Hypoglycaamia
Oligouria - Hyper K
Hydrocortisone then fludrocortisone.
Pre-tibial myxoedema
Thyroid Eye disease
Acropatchy
Grave’s
Sulfasalazine MoA
Inhibits T cell proliferation and IL-2 production by them…
Reduced neutrophil chemotaxis
Methotrexate
Antifolate???
