RA - Presentation & Treatment Flashcards
What joints are affected by RA?
Potentially any synovial joint, however:
- Symmetrical!
- Mostly peripheral
- Mostly small joints
- Mostly multiple joints
Signs of RA?
Tenderness
Swelling
Restriction of Movement
Sometimes heat/redness
Symptoms of RA?
Pain
Stiffness
Functional Impairment and poor mobility
Fatigue
What are some potential systemic features of RA?
- Weight loss
- Anaemia
- Scleritis
- Interstitial lung disease & fibrosis
- Nerve disease
- Cutaneous vasculitis & ulceration of skin
- Kidney disease
Long term CVD
What tests can we run for RA?
Rheumatoid factor - mostly redundant these days
ACPA & Anti-CCP antibodies (Anti-cyclic Citrullinated Proteins)
X-ray
Doppler US (to see inflammation)
ESR/CRP
How do we perform ongoing assessments to monitor our RA patients?
Calculate a Disease Activity Score (DAS)
<2.4 = clinical remission
>5.1 = eligible for biologics
How does RA affect peoples ability to work?
According to the NAO report 2009:
- 33% will be off work within 2 yrs
- 50% within 10yrs
Early & Aggressive is the modern mantra for RA therapy, why?
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.
What drug categories can be prescribed for RA?
- NSAIDs
- Disease Modifying Anti-rheumatic Drugs (DMARD)
- Biologics
- CCS
When are NSAIDs used for RA?
As symptomatic medication, not a long-term treatment
What drugs are used as DMARDs?
Mainly Methotrexate Also: - Sulfasalazine - Hydroxychloroquine - Leflunomide
Whats the benefit of Biologics vs traditional DMARDs?
Biologics act faster, DMARDs take a few months to show effect.
Biologics are less dangerous
Most effective when combined with MEthotrexate
List some biologic agents used for RA?
- TNF-Alpha inhibitors
- IL-1 Inhibitors (Anakinra)
- IL-6 inhibitors (Tocilizumab)
- Anti-B cell Therapy (Rituximab)
- Anti-T Cell Therapy (Abatacept)
When and how are CCS used for RA?
Short term therapy for flare ups etc.
Oral / IM / IA / IV infusion
Mnemonic for the features of RA = ANTICCP OR F
Arthritis Nodules Tenosynovitis Immunology (ACCP & RF) Carpal Tunnel Cardiac Pleural effusion Opthalmology Raynaud's Felty Syndrome