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Part 3 – PM3B COPY T > (PM3B) Rheumatoid Arthritis > Flashcards

(PM3B) Rheumatoid Arthritis Flashcards

1
Q

What are the pharmacological treatments of rheumatoid arthritis?

A

(1) Analgesics
(2) Glucocorticoids –corticosteroids
(3) DMARDs

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2
Q

What are csDMARDs?

A

Conventional synthetic DMARDs

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3
Q

What are bDMARDs?

A

Biological DMARDs

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4
Q

What are tsDMARDs?

A

Targeted synthetic DMARDs

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5
Q

What is inflammatory arthritis?

A

Group of diseases characterised by inflammation of the joints

e.g. RA/ psoriatic arthritis/ ankylosing spondylitis/ juvenile idiopathic arthritis

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6
Q

What is the cause of inflammatory arthritis?

A

Autoimmune disorders

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7
Q

What are the symptoms of inflammatory arthritis?

A

(1) Joint pain/ swelling

(2) Joint stiffness
- lasting more than 30 minutes

(3) Normochromic/ normocytic anaemia

(4) Raised inflammatory markers
- ESR
- CRP

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8
Q

What is synovitis?

A

Synovial inflammation

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9
Q

At what age is peak prevalence of menopause?

A

40-60 years old

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10
Q

Describe the symptoms of rheumatoid arthritis.

A

Vary in severity

Can flare/ alternate with periods of remission

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11
Q

What causes the inflammatory response in rheumatoid arthritis?

A

Non-specific inflammatory response

Localised tissue damage causes release of neo-autoantigens

Leads to T cell activation

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12
Q

How are pro-inflammatory cytokines and chemokines produced in rheumatoid arthritis?

A

(1) B cells activate + produce autoantibodies
- rheumatoid factor
- anti-CCP

(2) Form immune complexes
(3) Bind to complement
(4) Stimulate neutrophils
(5) Production of pro-inflammatory cytokines + chemokines

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13
Q

How is rheumatoid arthritis characterised?

A

Chronic synovitis

Due to migration + retention of inflammatory cells

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14
Q

What causes chronic synovitis in rheumatoid arthritis?

A

Migration + retention of inflammatory cells at site of inflammation

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15
Q

Explain the migration and retention of inflammatory cells at the site of inflammation in rheumatoid arthritis.

A

(1) Response to pro-inflammatory mediators
(2) Leukocytes + vascular cells are activated

(3) T cells extravasate from blood vessels into synovium
- synovium = inflammation zone

(4) T cells retained in inflammation zone
(5) New blood vessels are formed

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16
Q

What is the synovium in rheumatoid arthritis?

A

The inflammation zone

17
Q

What is synovial hyperplasia?

A

Tissue growing out of cartilage surface

Called a pannus

18
Q

What is a pannus?

A

Growth out of cartilage surface in synovial hyperplasia in rheumatoid arthritis

Destroys articular cartilage + subchondral bone
- produces bony erosions

19
Q

What are some of the clinical features of rheumatoid arthritis?

A

(1) Gradual (insidious) onset of pain

(2) Early-morning stiffness
- >30mins

(3) Symmetrical swelling in small joints of hands + feet
(4) Deformity
(5) Muscle wasting

(6) Joint effusions
- increased fluid in tissue surrounding joint

20
Q

How is deformity caused in rheumatoid arthritis?

A

(1) Joint capsules are weakened
(2) Leads to instability
(3) Partial dislocation (subluxation)
(4) Deformity

21
Q

What are some non-articular features of rheumatoid arthritis?

A

(1) Bursitis

(2) Tenosynovitis
- inflammation of tendon sheath lining

22
Q

What are some extra-articular features of rheumatoid arthritis?

A

(1) Fever
(2) Fatigue
(3) Anaemia
(4) Nodules
(5) Muscle wasting

(6) Sjogren’s syndrome
- dry eyes + mouth
- due to destruction of epithelial exocrine glands

(7) Carpal tunnel syndrome
- median nerve compression in the wrist

23
Q

What can rheumatoid arthritis cause an increased risk of?

A

(1) CVD/ atherosclerosis

(2) Infection
- usually pulmonary

(3) Osteoporosis

24
Q

What should be done with a patient with suspected rheumatoid arthritis or suspected synovitis of undetermined cause?

A

Urgent referral to rheumatologist IF:

(1) Small joints of hands/ feet are affected
(2) >1 joint is affected
(3) Delay of >3 months between onset of symptoms + seeking medical advice

25
Q

When should a blood test for rheumatoid factor be taken?

A

In suspected rheumatoid arthritis

With synovitis on clinical examination

26
Q

When should an anti-cyclic citrullinated peptide (anti-CCP) antibody measurement be taken?

A

Suspected rheumatoid arthritis

If negative for rheumatoid factor

27
Q

When should a patient with suspected rheumatoid arthritis be X-rayed?

A

(1) Presence of persistent synovitis

(2) X-ray hands + feet only

Part 3 – PM3B COPY T (33 decks)

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