RA Flashcards
Rheumatoid Arthritis?
• chronic inflammatory, autoimmune disease
Persistent symmetric polyarthritis
Which membrane is affected?
Synovial membrane
Clinical presentation?
• onset of fever and malaise
S&S:
• synovitis
• progressive worsening of joint
• difficulty in performing daily activities
Which upper extremists affected?
• shoulders
• elbows
• wrists
Which lower extremists affected?
• hips
• knees
• ankles
• feet
Epidemiology?
• women are 3 times affected
• 1st degree relativise of RA with 2-3 folds
Genetic causes?
• HLA- DR4 (increases severity and development)
Lifestyle Causes?
- increased smoking
- read meat intake
- vit D deficiency
- excessive coffee consumption
- high salt intake
Hormonal Causes?
Prolactin - disproportionate between male and female
Stages of RA?
• Phase I - interaction (genetis and environmental risk)
• Phase Il - production of Ra
autoantibodies - RF & anti-CCP
• Phase III - begin joint stiffness
• Phase IV - development of arthritis
• Phase V - established RA
Which Immune cells are involved?
B-cells & T-cells
• these cells inappropriately enter the joint and release cytokines
• cytokines cause the synovium to release proteolytic - destroying bone & cartilage
Diagnosis?
• blood test
• history
• symptoms
• X-ray
Differential diagnosis?
• gout
• tuberculosis
• psoriatic arthritis
Lab test - serology
• CRP & ESR - raised in active disease
• IgM- FR
• anti-CCP
DAS-28 assessment
DAS28 >5.1 = active disease
DAS28 >3.2 = low disease activity
DAS28 >2.6 remission
Non-pharmacological Management?
• physiotherapy
• exercise, diet
• surgery
• educating stress management
Pharmacological Management?
• Analgesics
• NSAIDs
• Glucocorticoids
• DMARDS
• Biologicals
Analgesics?
• paracetamol
• opioid
NSAID?
• traditional
• cox-2 selective inhibitors
Consider:
• pro thrombotic affect - cox-2
• worsen cardiac risk
• GI, rental and hepatic toxicity
Glucocorticoids?
• prednisone
• methylprednisolone
Only short term
Long term - if other treatments have been offered
Examples of DMARDs
First line!
• methotrexate
• sulfasalazine
• leflunomide
• hydroxychloroquine
Offer combination if target has not been achieved
Side effects Of DMARDs ?
Methotrexate- liver impairment
Sulfasalazine - cough, diarrhoea, fever
Leflunomide - diarrhoea
Hydroxychloroquine - ocular impairment
Biologicals?
• used in combination with methotrexate - in DAS28 > 5.1 (disease has not responded to DMARDS)
• can be used in mono therapy if methotrexate is C/I
Which parts of the body can also be affected?
• skin
• lungs
• nervous system
• musculoskeletal
Patients typical journey
• Patient presents to their GP
• Initiation with analgesics/NSAIDs and refereed to a Rheumatology specialist
• If diagnosed with RA - treatment with one or two DMARDs starts
• If patients DAS28 remains above 5.2 after fix months then start treatment with a biologicals
