Progression and treatment of RA / Flashcards

1
Q

What are the characteristics of inflammatory arthritis?

A
  • Symptoms tend to lead to ease with activity
  • Early morning stiffness present
  • Onset often acute/sub-acute
  • Systematic upset
  • Raised blood tests of inflammation - ESR, CRP, PCT
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2
Q

What are the characteristics of non-inflammatory arthritis?

A
  • Symptoms worse with activity
  • Minor morning stiffness
  • Usually gradual onset
  • No systematic upset
  • Blood tests usually normal
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3
Q

What is the most common type of arthritis?

A

Osteoarthritis

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4
Q

Is RA hereditary?

A

No, only the factors that increase your risk of having it can be hereditary

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5
Q

Which joints in the body does RA spare?

A

DIPs - distal interphalangeal joints
Vertebral joints especially the atlanto-axial joint

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6
Q

What are classical sub-acute presenting symptoms of new RA?

A
  • Pain and stiffness in hands, wrists, feet +/- large joints
  • 1 hour morning stiffness
  • +/- joint swelling
  • Undue fatigue
  • Difficulties with certain activities - opening jars, bottles, keys
  • Can have more prominent systematic symptoms e.g. weight loss
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7
Q

What are the special features to ask in history taking of RA? ***

A

Skin problems - scaly rash (psoriasis)
Eye problems - grittiness, acute red eyes, red eye + blurred vision
Dry mouth
Alopecia
Raynaurd’s
Preceding illness
Family history

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8
Q

What may be found in general examination of RA? ***

A

May be normal
Anaemia
Lymphadenopathy
Palmar erythema
Look for rashes, nail dystrophy, tophi

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9
Q

What may be found in joint examination in RA?

A

Articular tenderness - especially PIPs and MCPs, wrists, MTPs
Soft tissue swelling of joints +/- effusions
Functional impairment:
- Diminished grip strength
- Impaired fist formation
- Inability to extend elbows fully

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10
Q

What does this picture show?

A

Fusiform swelling

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11
Q

What does this picture show?

A

Subcutaneous nodule

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12
Q

What blood tests will be ordered to investigate RA?

A

FBC
ESR - erythrocyte sedimentation rate
CRP - C reactive protein
U&Es - K+, Na+, urea, creatinine
LFTs
Serum urate
Consider thyroid function, glucose
Autoantibodies

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13
Q

What is more sensitive and specific to RA: RHF or anti CPP?

A

Anti CPP is more specific and sensitive

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14
Q

What can RF also be found in?

A

2-4% of normal pop
Other autoimmune conditions
Chronic infections e.g. TB, syphilis
Viral infections e.g. EBV
B cell lymphoproliferative disease

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15
Q

What autoantibodies are present with RA?

A

Anti CPP - sensitivity 50-70%, sensitivity 90-95%. May be present years before arthritis onset
Anti-nuclear antibody (ANA) - stronger associations with other diseases. also in pulmoanry diseases, infections and malignancies. Low positives in normal

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16
Q

What X-rays may be taken to assess for RA?

A

Chest x-ray: check for conditions that may present with joint problems. Look for RA lung involvement
Hands and feet: tend to be earliest sign - soft tissue swelling, juxta-articular osteopenia, erosions

17
Q

Why is US used to assess for RA?

A

Sensitive way of detecting synovitis and tenosynovitis
Can detect erosions sensitively

18
Q

What does uncontrolled RA lead to?

A

Increasing joint damage and deformity
Increasing disability - many unable to work after 5 yrs of RA
Increased mortality - inflammatory impact in cardiovascular system

19
Q

What are the joint manifestations of RA?

A

Subluxation
Swan neck deformity
Bountonniere deformity
Protruding metatarsal heads
Reduced joint space
Erosions

20
Q

What are some extra-articular manifestations of RA?

A

Eyes: dry eyes, slceritis, episcleritis
Skin: ulcers
NS: carpal tunnel syndrome, peripheral neuropathy
Blood vessels: premature atherosclerosis, vasculitis
Lungs: pulmonary fibrosis, pulmonary nodules
Heart: pericarditis
Blood: anaemia

21
Q

What are the main principles of RA treatment?

A

Control symptoms
Minimise impact
Minimise joint damage
Maximise function

22
Q

What drug treatments are given to patients with RA?

A

Analgesics: including NSAIDs - but significant side effects
DMARDs: improves symptoms and may slow progression. Serious side effects. Methotrexate, hydroxychloroquine, sulfasalazine
Corticosteroids: relief for inflammation
Biologic agents: target specific immune molecules, expensive. Anti-TNF