RA - Presentation & Treatment Flashcards

1
Q

What joints are affected by RA?

A

Potentially any synovial joint, however:

  • Symmetrical!
  • Mostly peripheral
  • Mostly small joints
  • Mostly multiple joints
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2
Q

Signs of RA?

A

Tenderness
Swelling
Restriction of Movement
Sometimes heat/redness

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3
Q

Symptoms of RA?

A

Pain
Stiffness
Functional Impairment and poor mobility
Fatigue

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4
Q

What are some potential systemic features of RA?

A
  • Weight loss
  • Anaemia
  • Scleritis
  • Interstitial lung disease & fibrosis
  • Nerve disease
  • Cutaneous vasculitis & ulceration of skin
  • Kidney disease
    Long term CVD
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5
Q

What tests can we run for RA?

A

Rheumatoid factor - mostly redundant these days
ACPA & Anti-CCP antibodies (Anti-cyclic Citrullinated Proteins)
X-ray
Doppler US (to see inflammation)
ESR/CRP

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6
Q

How do we perform ongoing assessments to monitor our RA patients?

A

Calculate a Disease Activity Score (DAS)
<2.4 = clinical remission
>5.1 = eligible for biologics

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7
Q

How does RA affect peoples ability to work?

A

According to the NAO report 2009:

  • 33% will be off work within 2 yrs
  • 50% within 10yrs
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8
Q

Early & Aggressive is the modern mantra for RA therapy, why?

A

Treating RA early and aggressively instead of starting small is shown to have the best outcome and effect on the DAS.
Earlier treatment suppresses inflammation and prevents damage being done to the joint and bone.

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9
Q

What drug categories can be prescribed for RA?

A
  • NSAIDs
  • Disease Modifying Anti-rheumatic Drugs (DMARD)
  • Biologics
  • CCS
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10
Q

When are NSAIDs used for RA?

A

As symptomatic medication, not a long-term treatment

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11
Q

What drugs are used as DMARDs?

A
Mainly Methotrexate
Also:
- Sulfasalazine
- Hydroxychloroquine
- Leflunomide
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12
Q

Whats the benefit of Biologics vs traditional DMARDs?

A

Biologics act faster, DMARDs take a few months to show effect.
Biologics are less dangerous

Most effective when combined with MEthotrexate

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13
Q

List some biologic agents used for RA?

A
  • TNF-Alpha inhibitors
  • IL-1 Inhibitors (Anakinra)
  • IL-6 inhibitors (Tocilizumab)
  • Anti-B cell Therapy (Rituximab)
  • Anti-T Cell Therapy (Abatacept)
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14
Q

When and how are CCS used for RA?

A

Short term therapy for flare ups etc.

Oral / IM / IA / IV infusion

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15
Q

Mnemonic for the features of RA = ANTICCP OR F

A
Arthritis
Nodules
Tenosynovitis
Immunology (ACCP &amp; RF)
Carpal Tunnel
Cardiac
Pleural effusion
Opthalmology
Raynaud's
Felty Syndrome
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16
Q

Mnemonic for x-ray findings of RA = LESSS

A
Loss of joint space
Erosions
Soft bones (periarticular arthritis)
Soft tissue Swelling
Subluxation