RA

Question 1

What is the definition of RA?

Answer 1

• Chronic, inflammatory, autoimmune disorder

- Involves the movement of fluid and WBCs into extravascular tissues

Question 2

What is RA characterised by?

Answer 2

• Synovitis
• Thickening
• Infiltration

Question 3

Explain the brief pathophysiology of RA?

Answer 3

1. Environmental/ genetic factors - cause Ab and protein modification
2. Immune cells dont recognise new proteins as self-antigens
3. Auto-Ab formed against the self antigen - RF, anticyclic citrullinated peptide immune complexes
   - Cytokines cause synovial cells to proliferate and grow over articular cartilage which creates a pannus (a thick swollen synovial membrane with granulation tissue
   - Pannus damages the cartilage and erodes the bone
   - Without cartilage the bone is exposed and rubs agaisn’t each other - producing bony erosions
   - Immune complexes form RF + EgG and anti-CCP + citrullinated proteins

Question 4

What are the risk factors of RA?

Answer 4

• Gender - women
• age - 40-60 most common
• fx
• Genetic factors
• Smoking

Question 5

Is RA symmetrical or asymmetrical?

Answer 5

Symmetrical

Question 6

Does it usually occur in more than one joint?

Answer 6

Yes, >5

Question 7

What joints do RA arthritis start in?

Answer 7

Smaller joint e.g MCP PIP and MTP. Larger joints are usually affected later

Question 8

What damage and deformities can be seen in RA?

Answer 8

• Swan neck
• Boutonniere
• Z thumb deformity
• Ulnar deviation
• Subluxation

Question 9

What extraarticular involvement is seen in RA?

Answer 9

• Rheumatoid nodules form at pressure points
• Rarely - lungs , heart and sclera
• INterstitial lung fibrosis and pleural effusion
• Dorsal and lumbar spine are not involved

Question 10

What are the symptoms of RA?

Answer 10

• Pain worse in the morning (lasting more than 30 mins, may improve with activity)
• Morning stiffness
• General fatigue and malaise

Question 11

Is testing for RF diagnostic of RA?

Answer 11

No, its is positive in RA but is also positive in other conditions as well

Question 12

What test is useful for distinguishing early RA from acute transient synovitis?

Answer 12

• Anti-cyclic citrullinated peptide (its a marker for RA but not pathogenic in itself

Question 13

What would you see on an XR in RA?

Answer 13

L - Loss of joint space
E - Erosions
S - Soft tissue swelling
S - soft bones (osteopaenia)

Question 14

What are some soft tissue complications found in RA?

Answer 14

• Nodules
• Bursitis
• Muscle wasting

Question 15

What are some complications found in the eyes in RA?

Answer 15

• Episcleritis
• Scleritis
• Necrotising scleritis

Question 16

What complication can be found in the skin?

Answer 16

Vasculitis

Question 17

What is the non-pharamacological treatment for RA?

Answer 17

• Rehabilitation
• Occupational therapy to find aids to reduce disability
• Smoking cessation
• Deal with depression

Question 18

What is the pharmacological treatment for RA?

Answer 18

• DMARDs

Question 19

Give two examples of DMARDs?

Answer 19

• Sulfasalazine

- Methotrexate

Question 20

What do biological DMARDs do?

Answer 20

• TNF-alpha inhibitors

- IL- 1 receptor blockers

Question 21

What can be used in RA secondary to DMARDs?

Answer 21

• Steroids

- NSAIDs