RA Flashcards
What type of condition is rheumatoid arthritis?
It is an autoimmune condition that causes chronic inflammation in the synovial lining of joints, tendon sheaths, and bursa.
What is synovitis?
Inflammation of the synovial lining of the joints.
What does rheumatoid arthritis typically affect?
It affects multiple small joints symmetrically, known as symmetrical polyarthritis.
How much more common is rheumatoid arthritis in women than men?
It is 2-3 times more common in women.
What are some risk factors for rheumatoid arthritis?
- Smoking
- Obesity
- Family history (though there is no clear inheritance pattern)
What gene is most commonly associated with rheumatoid arthritis?
HLA DR4.
What is the range of disease progression in rheumatoid arthritis?
The disease can range from mild and remitting to severe and progressive.
What are the two main antibodies associated with rheumatoid arthritis?
- Rheumatoid factor (RF)
- Anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies)
How common is rheumatoid factor in rheumatoid arthritis patients?
It is present in around 70% of RA patients.
How sensitive and specific are anti-CCP antibodies for rheumatoid arthritis?
Anti-CCP antibodies are more sensitive and specific than rheumatoid factor and are positive in around 80% of RA patients.
What are the three joint symptoms of rheumatoid arthritis?
- Pain
- Stiffness
- Swelling
What joints are most commonly affected by rheumatoid arthritis?
- Metacarpophalangeal (MCP) joints
- Proximal interphalangeal (PIP) joints
- Wrist
- Metatarsophalangeal (MTP) joints (in the foot)
How do affected joints feel on palpation in rheumatoid arthritis?
They feel tender and have synovial thickening, giving a ‘boggy’ feeling.
Which joints are rarely affected by rheumatoid arthritis?
The distal interphalangeal (DIP) joints.
What are some systemic symptoms associated with rheumatoid arthritis?
- Fatigue
- Weight loss
- Flu-like illness
- Muscle aches
- Weakness
How do symptoms of inflammatory arthritis differ from those of mechanical problems like osteoarthritis?
Inflammatory arthritis symptoms worsen with rest and improve with activity, and are worst in the morning.
What is palindromic rheumatism?
It involves self-limiting episodes of inflammatory arthritis, typically affecting only a few joints, with symptoms lasting days and resolving completely between episodes.
What are some hand signs in advanced rheumatoid arthritis?
- Z-shaped deformity to the thumb
- Swan neck deformity
- Boutonniere deformity
- Ulnar deviation of the fingers at the MCP joints
What causes Boutonniere deformity?
A tear in the central slip of the extensor mechanism at the PIP joint, causing hyperextension of the DIP joint and flexion of the PIP joint.
What is the cause of Swan neck deformity?
An imbalance of the extensor mechanism causing flexion of the DIP joint and extension of the PIP joint.
What is atlantoaxial subluxation in rheumatoid arthritis?
It occurs in the cervical spine when synovitis and damage to ligaments around the odontoid peg of the axis (C2) cause it to shift within the atlas (C1), potentially leading to spinal cord compression.
What are some extra-articular manifestations of rheumatoid arthritis?
- Pulmonary fibrosis
- Felty’s syndrome
- Sjögren’s syndrome
- Anemia of chronic disease
- Cardiovascular disease
- Eye manifestations
- Rheumatoid nodules
- Lymphadenopathy
- Carpal tunnel syndrome
- Amyloidosis
- Bronchiolitis obliterans
- Caplan syndrome
What eye manifestations are associated with rheumatoid arthritis?
- Dry eye syndrome (keratoconjunctivitis sicca)
- Episcleritis
- Scleritis
- Keratitis
- Cataracts (from steroids)
- Retinopathy (from hydroxychloroquine)
What investigations are useful in the initial assessment of rheumatoid arthritis?
- Rheumatoid factor
- Anti-CCP antibodies
- Inflammatory markers (CRP, ESR)
- X-rays of the hands and feet
- Ultrasound or MRI for detecting synovitis
What are common X-ray changes in rheumatoid arthritis?
- Periarticular osteopenia
- Bony erosions
- Soft tissue swelling
- Joint destruction and deformity in more advanced disease
What scoring systems are used in rheumatoid arthritis?
- The Health Assessment Questionnaire (HAQ)
- The Disease Activity Score 28 Joints (DAS28)
What is the treatment aim for rheumatoid arthritis?
To induce remission or get as close to remission as possible, with early treatment improving outcomes.
What medications are used to treat rheumatoid arthritis?
- Conventional disease-modifying anti-rheumatic drugs (cDMARDs)
- Biologic DMARDs
- Short-term steroids for flare-ups
What are some common cDMARDs used in rheumatoid arthritis?
- Methotrexate
- Leflunomide
- Sulfasalazine
What are some biologic therapies used in rheumatoid arthritis?
- TNF inhibitors (e.g., adalimumab, infliximab, etanercept)
- Anti-CD20 (e.g., rituximab)
- Anti-interleukin-6 inhibitors (e.g., sarilumab)
- JAK inhibitors
- T-cell co-stimulation inhibitors
What are the side effects of methotrexate?
- Mouth ulcers
- Liver toxicity
- Bone marrow suppression
- Leukopenia
- Teratogenic effects
What are the side effects of leflunomide?
- Mouth ulcers
- Increased blood pressure
- Liver toxicity
- Bone marrow suppression
- Leukopenia
- Peripheral neuropathy
- Teratogenic effects
What are the side effects of sulfasalazine?
- Orange urine
- Reversible male infertility
- Bone marrow suppression
What are the side effects of hydroxychloroquine?
- Retinal toxicity
- Blue-grey skin pigmentation
- Hair lightening
What are the unique side effects to remember for the medications used in rheumatoid arthritis?
- Methotrexate: Bone marrow suppression and leukopenia, highly teratogenic
- Leflunomide: Hypertension and peripheral neuropathy
- Sulfasalazine: Orange urine and male infertility
- Hydroxychloroquine: Retinal toxicity, blue-grey skin pigmentation, and hair bleaching
- Anti-TNF medications: Reactivation of tuberculosis
- Rituximab: Night sweats and thrombocytopenia
