RA

Question 1

What is RA

Answer 1

Inflammatory autoimmune response
Progressive joint damage inflammation within synovial joints causing pain swelling stiffness erosion and joint destruction

Question 2

Where does RA affect

Answer 2

Usually joints symmetrically shoulders, wrists, hands, elbows, knees, ankles

Question 3

What are the symptoms of RA

Answer 3

Morning stiffness MORE than 1 hr
Pain
Swelling
Inflammation
Joints hot and tender to touch
Sometimes fever and fatigue

Question 4

What are risk factors of RA

Answer 4

Woman
Obese
Family history
Smoking
Genetic factors

Question 5

What is diagnosis of RA

Answer 5

Family history, pain history and examination of joints

X-ray - joint damage
DAS28 to monitor initial severity
CPR and ESR - inflammation makers (will be raised)

Question 6

What is the treatment of RA

Answer 6

1st line methotrexate
Sulfalazine
Leflunomide
Hydroxchlorine

Question 7

Methotrexate and leflunomide MOA

Answer 7

Reduce DNA production in immune cells, preventing proliferation

Question 8

Sulfsalazine (5ASA) MOA

Answer 8

Inhibition of inflammation mediators
- prostaglandins
- leukotrienes
- platelet activating factor
- cyclooxgenase

Question 9

Key mechanism in RA

Answer 9

Citrullination of proteins

Question 10

What is a pannus

Answer 10

Thickening if the synovial membrane which contains immune cells and macrophages

Question 11

Immune response releases ‘cytokines’ which are linked to RA what are they

Answer 11

TNF-a
IL 1
IL6

Question 12

Methotrexate SERIOUS SE

Answer 12

STOP and report ASAP SAME day
Sore throat, bruising, mouth ulcers - blood disorders

Nausea, Vomiting, dark urine - liver toxicity

Shortness of breath and dry cough, fever - respiratory effects

STOP bone marrow suppression - reduced white blood or platelets

STOP taking if have infection requiring antibiotics and report any signs of infection to GP

Question 13

Methotrexate CI and cautions

Answer 13

NSAIDS (increased risk of toxicity)
Alcohol ( increased risk of liver toxicity)
Trimethoprim, Amoxcillin
Live vaccines
AVOID ppl with chicken pox / measles
Pregnancy

Question 14

Sulfaslazine SE and SERIOUS SE

Answer 14

Orange urine and stain tears and lenses yellow (normal)

STOP and REPORT ASAP
Sore throat, brushing, bleeding, fever, purple rash - blood disorder

Question 15

Leflunomide CI and cautions

Answer 15

Pregnancy - contraception for 2 years and 3 months for men after treatment ( wash out protocol can reduce this)

STOP taking if infection needing antibiotics

Question 16

Hydroxychloroquine SERIOUS SE

Answer 16

Need eye tests can damage eyes