RA Flashcards
What is the limitation of the new biologic drugs?
The immune system adapts to circumvent the suppression
What is ACR20?
Clinical (patient and physician opinion) and radiological evaluation of treatment efficacy for a overall 20% improvement
What are some radiological signs that can be found in RA?
Periarticular erosions
Osteopenia
Ulnar subluxations at MCP joints
Fluffy erosions at MCP and PIP
Soft tissue swelling
How does RA synovitis feel on palpation?
Boggy
What is the combination therapy for RA?
Methotrexate
Hydroxylchloroquine
Sulphasalazine
What is reactive arthritis?
Immune complex mediated arthritis and myalgia post acute infection
What are the biological DMARDs?
TNF inhibitors - etanercept, infliximab
B cell inhibitor - rituximab
Cell adhesion inhibitor - abatacept
IL-6 inhibitor -Tocilizumab
What is the epidemiology of RA?
More common in women
What are some DDx for pain and stiffness in small joints of the hands?
RA
Reactive arthritis
Lupus
How are corticosteroids administered in RA?
Oral
Intra-articular
What is the name of the palpation finding in RA?
Synovitis
What is the best imaging to assess damage caused by inflammatory arthritis?
MRI
What are the DMARDs?
Hydrochloroquine
Sulphasalazine
Methotrexate
Leflunomide
How in RA treated pharmacologically?
Analgesic
Anti-inflammatory drugs
Disease modifying anti-rheumatic drugs
Which clinical feature can reflect the severity of a patient’s RA?
The duration of morning stiffness
What does lupus differ from RA on examination?
Synovitis is rarely present in lupus where it’s a feature of RA
Arthralgia is more common in lupus
How has the methods of RA treatment changed?
Start with combination (methotrexate, sulphasalazine, hydroxychloroquine)
Then wean to maintenance therapy
Outline the ACR 1987 classification criteria for RA diagnosis
Patients must have 4 out of these 7
- Morning stiffness >1 hour
- Swelling in joints of the hand
- Swelling in 3 or more joints
- Symmetrical joint swelling
- Erosions or calcifications on Xray
- Positive rheumatoid factor
- Rheumatoid nodules
How does the timecourse differ in inflammatory arthritis and mechanical arthritis?
Mechanical arthritis takes much longer and develops insipidusly over months
How do you Ix for inflammatory arthritis?
Rheumatoid factor, anti-Citrullinated Protein ab, anti-ANA ab
CRP, ESR
FBE - ?anaemia
MRI
How does RA present?
Arthritis of the small joints of the hand and feet
Deformity - valgus knee
Systemic signs - Fever, malaise, weight loss
What is naproxen?
An NSAID commonly used in arthritis’
How does methotrexate compare to the biologics in treating RA?
Not much different
What is the greatest environmental risk factor for RA?
Smoking
What is the pathophysiology of RA?
Autoimmune destruction of the synovial membrane and ongoing inflammation
