RA

Question 1

What is the limitation of the new biologic drugs?

Answer 1

The immune system adapts to circumvent the suppression

Question 2

What is ACR20?

Answer 2

Clinical (patient and physician opinion) and radiological evaluation of treatment efficacy for a overall 20% improvement

Question 3

What are some radiological signs that can be found in RA?

Answer 3

Periarticular erosions

Osteopenia

Ulnar subluxations at MCP joints

Fluffy erosions at MCP and PIP

Soft tissue swelling

Question 4

How does RA synovitis feel on palpation?

Answer 4

Boggy

Question 5

What is the combination therapy for RA?

Answer 5

Methotrexate

Hydroxylchloroquine

Sulphasalazine

Question 6

What is reactive arthritis?

Answer 6

Immune complex mediated arthritis and myalgia post acute infection

Question 7

What are the biological DMARDs?

Answer 7

TNF inhibitors - etanercept, infliximab

B cell inhibitor - rituximab

Cell adhesion inhibitor - abatacept

IL-6 inhibitor -Tocilizumab

Question 8

What is the epidemiology of RA?

Answer 8

More common in women

Question 9

What are some DDx for pain and stiffness in small joints of the hands?

Answer 9

RA

Reactive arthritis

Lupus

Question 10

How are corticosteroids administered in RA?

Answer 10

Oral

Intra-articular

Question 11

What is the name of the palpation finding in RA?

Answer 11

Synovitis

Question 12

What is the best imaging to assess damage caused by inflammatory arthritis?

Answer 12

MRI

Question 13

What are the DMARDs?

Answer 13

Hydrochloroquine

Sulphasalazine

Methotrexate

Leflunomide

Question 14

How in RA treated pharmacologically?

Answer 14

Analgesic

Anti-inflammatory drugs

Disease modifying anti-rheumatic drugs

Question 15

Which clinical feature can reflect the severity of a patient’s RA?

Answer 15

The duration of morning stiffness

Question 16

What does lupus differ from RA on examination?

Answer 16

Synovitis is rarely present in lupus where it’s a feature of RA

Arthralgia is more common in lupus

Question 17

How has the methods of RA treatment changed?

Answer 17

Start with combination (methotrexate, sulphasalazine, hydroxychloroquine)

Then wean to maintenance therapy

Question 18

Outline the ACR 1987 classification criteria for RA diagnosis

Answer 18

Patients must have 4 out of these 7

1. Morning stiffness >1 hour
2. Swelling in joints of the hand
3. Swelling in 3 or more joints
4. Symmetrical joint swelling
5. Erosions or calcifications on Xray
6. Positive rheumatoid factor
7. Rheumatoid nodules

Question 19

How does the timecourse differ in inflammatory arthritis and mechanical arthritis?

Answer 19

Mechanical arthritis takes much longer and develops insipidusly over months

Question 20

How do you Ix for inflammatory arthritis?

Answer 20

Rheumatoid factor, anti-Citrullinated Protein ab, anti-ANA ab

CRP, ESR

FBE - ?anaemia

MRI

Question 21

How does RA present?

Answer 21

Arthritis of the small joints of the hand and feet

Deformity - valgus knee

Systemic signs - Fever, malaise, weight loss

Question 22

What is naproxen?

Answer 22

An NSAID commonly used in arthritis’

Question 23

How does methotrexate compare to the biologics in treating RA?

Answer 23

Not much different

Question 24

What is the greatest environmental risk factor for RA?

Answer 24

Smoking

Question 25

What is the pathophysiology of RA?

Answer 25

Autoimmune destruction of the synovial membrane and ongoing inflammation