RA + its drugs- 4th year

Question 1

1st line management of RA

Answer 1

DMARD monotherapy +/- short course of bridging prednisolone

Question 2

2nd line RA management

Answer 2

DMARD combination therapy

Question 3

no response to atleast 2 DMARDs including methotrexate management RA?

Answer 3

Biologics

Question 4

Give examples of DMARDS

Answer 4

-Methotrexate
-Sulfalazine
-Leflunomide
-Hydroxychloroquine

Question 5

mildest DMARD + what is it often used for?

Answer 5

-Hydroxychloroquine

mild RA + palindromic rheumatism (inflammatory arthritis that only lasts a few days)

Question 6

side effects of methotrexate + what monitoring needs done?

Answer 6

-myelosupression
-liver cirrhosis
-pneumonitis

need to monitor FBC + LFTs

Question 7

what biologics are commonly used in RA?

Answer 7

-TNF inhibitors
-Rituximab

Question 8

Give examples of TNF inhibitors

Answer 8

Infliximab- monoclonal antibody

adalimumab- monoclonal antibody

Etanercept- recombinant human protein

Question 9

what is rituximab

Answer 9

anti- CD 20 monoclonal antibody

type of biologic

Question 10

SE of biologics?

Answer 10

-immunosuppression
-increased risk of non melanoma skin cancer
-reactivation of latent TB

Question 11

what med should be taken alongside methotrexate?

Answer 11

folic acid 5mg once a week

Question 12

SE sulfasalazine (DMARD)

Answer 12

-Orange urine
-Male infertility (reduced sperm count)

Question 13

SE hydroxychloroquine (DMARD)

Answer 13

-Retinal toxicity
-Blue- grey skin pigmentation
-Hair bleaching

Question 14

SE leflunomide (DMARD)

Answer 14

-Hypertension
-Peripheral neuropathy

Question 15

SE rituximab (biologic)

Answer 15

night sweat + thrombocytopenia (low platelet)

Question 16

what score allows RA to be monitored?

Answer 16

DAS 28
-Disease activity score 28

Question 17

how is RA diagnosed?

Answer 17

Based on clinical findings and blood results

Blood results:
-Increased inflammatory markers (ESR + CRP)
-Anti CCP antibody (90%)
-RF (70%)

Question 18

what is seeen on Xray of RA?

Answer 18

-periarticular osteopenia
-boney erosions
-soft tissue swelling
-joint destruction and deformity

Question 19

what signs may be seen in hands of someone with RA?

Answer 19

-Z shaped deformity in thumb
-ulnar deviation of MCP
-Swan neck deformity (hyperextended PIP + flexed DIP)
-Boutonniere deformity (flexed PIP + hyperextended DIP)

Question 20

what pattern does RA present in the joints?

Answer 20

symmetrical polyarthritis most commonly affects:
-MCP
-PIP
-Wrist
-MTP

Question 21

does it get worse or improve with activty?

Answer 21

improves with activity, worse at rest

Question 22

how long morning stiffness with RA?

Answer 22

> 30 mins

Question 23

eye manifestations of RA?

Answer 23

-Dry eye syndrome (keratoconjunctivitis sicca)
-Episcleritis
-Scleritis
-Keratitis

Question 24

what is Felty’s syndrome?

Answer 24

severe + rare disease presenting as RA, neutropenia + splenomegaly

Question 25

is severe RA in back, what ma occur?

Answer 25

Atlantoaxial subluxation
- Synovitis + damage to the ligaments around the odontoid peg of the axis (C2) allow it to shift within atlas (C1)
-Can cause spinal cord compression + is emergency

Question 26

gene linked to RA?

Answer 26

HLA DR4

Question 27

who is increased risk of RA?

Answer 27

W>M
Smokers
Obesity

Question 28

what is palindromic rheumatism?

Answer 28

-self limiting episodes of inflammatory arthritis, with pain, stiffness + swelling, typically only affecting a few joints
-symptoms typically last days and then completely resolves
-treat with hydroxychloroquine if needed