[Rheum] Polyarthritis Flashcards
what is rheumatoid arthritis (RA)?
a chronic autoimmune, inflammatory arthritis
what does RA present with?
- symmetrical synovitis (joint swelling for >6 weeks)
- pain the small joints of the hands and feet, improves with exercise
what is the 1st line ix for RA?
- bloods: RF, anti-CCP, ESR/CRP
- X-ray of the affected joints
what are the X-ray findings for RA?
- erosions
- loss of joint space
- Boutonniere’s deformity
what is the rx for RA?
- lifestyle modifications (exercise, wt loss, dietary advice)
- analgesia
- DMARDs with bridging steroids until sx control os manageable in an acute flare
what is the aim in RA rx and what is based off?
remission, based off DAS-28 score
what is the DAS-28 score?
scores the overall disease control by looking which joints are painful/swollen and coincides this with CRP/ESR
what is the 1st line pharmacological rx for RA?
monotherapy with conventional DMARD
- methotrexate
- sulfasalazine
- leflunomide
- hydroxychloroquine
what is done if target is not made with monotherapy?
tirate conventional DMARDs up +/- dual therapy
what is done if target is not made with dual therapy?
consider biological agents
*due to their high price, biologics are kept for pts with a severe burden of disease measured by DAS28 score (>5.1)
what can be seen on X-ray for osteoarthritis?
- loss of joint space and gull wing sign
- osteophytes
- multiple normal joints
red, scaly lesions on finger joints. dx?
Gottron’s papules (dermatomyositis)
episodes of white, cold digits. dx?
Raynaud’s phenomenon
telescopic digit. dx?
arthritis mutilans (psoriatic arthritis disease pattern)
what are the key features of RA?
- symmetrical synovitis
- no skin changes
- rheumatoid nodules
what are the blood tests/ix for RA?
- rheumatoid factor
- anti-CCP
- erosions and joint deformities on X-ray
what are the extra-articular manifestations of RA?
- respiratory (pulmonary fibrosis)
- cardiac (pericarditis)
- ocular (episcleritis/scleritis)
- renal (glomerulonephritis)
what are the rx for RA?
- DMARDs
- biologics
what are the key features of psoriatic arthritis?
- psoriatic plaques
- 5 different disease “patterns”
what are the blood tests for psoriatic arthritis?
- seronegative arthritis
- HLA-B27 association
what are the extra-articular manifestations of psoriatic arthritis?
- dactylitis
- nail disease (onycholitis, pitting)
what are the rx for psoriatic arthritis?
- DMARDs
- biologics
- steroid ointment
what are the key features for SLE?
- multiple organ systems affected
- SLICC criteria: 4/17 for dx
what are the blood tests for SLE?
- ANA (sensitive, not specific)
- anti dsDNA
- anti Smith
what are the extra-articular manifestations of SLE?
- arthritis >90%
- malar and discoid rashes
- constitutional sx (fever, wt loss, fatigue)
what is the rx for SLE?
- high dose steroids
- hydroxychloroquine
- biologics
what are the key features of ankylosing spondylitis?
- inflammatory back pain
- tendon insertion pain
- associated with UC
what are the blood tests for ankylosing spondylitis?
- seronegative arthritis
- HLA-B27 association
what are the extra-articular manifestations of ankylosing spondylitis?
- uveitis
- bowel involvement
- upper lobe pulmonary fibrosis
what is the rx for ankylosing spondylitis?
- NSAIDs/analgesia
- less commonly require biologics
what are the key features of osteoarthritis?
- no synovitis
- asymmetrical
- elderly /pre-existing joint injury
what are the blood tests for osteoarthritis?
- normal blood tests
- “LOSS” on X-ray
what is the rx for osteoarthritis?
- analgesic ladder
- gentle physiotherapy
- surgery
