RHEUMATHOID ARTHRITIS Flashcards
Symptoms of rheumatoid arthritis
Joint stiffness
Painful joints
Swelling of affected joints
Deformity of affected joints
Limitation of motion
Skin nodules
Difficulty in breathing
Easy fatiguability
External triggers for rheumatoid arthritis
Cigarette
Infection
Trauma
Signs of rheumatoid arthritis
Persistent symmetric polyarthritis (synovitis) of hands and feet
Joint stiffness
Joint tenderness
Joint swelling
Joint deformity
Limitation of joint movement
Rheumatoid nodules
Signs relating to extra-articular involvement e.g. lung disease, uveitis,
pericardial or pleural effusions
Investigations in rheumatoid arthritis
FBC
ESR
C-reactive protein level
Rheumatoid Factor assay
Antinuclear Antibody (ANA) assay
Anti−Cyclic Citrullinated Peptide (Anti-CCP)
Joint aspiration and analysis of synovial fluid
Hepatitis B and C tests
HIV test
X-rays of hands and feet
MRI of cervical spine (to detect subluxation)
Ultrasonography of joints
Treatment objectives in rheumatoid arthritis
To reduce pain, swelling and stiffness
To prevent deformities
To delay disease progression and long-term complications
To reduce drug side effects
Non-pharmacological interventions in rheumatoid arthritis
Heat and cold therapies
Orthotics and splints
Physiotherapy
Occupational therapy
Adaptive equipment
Joint-protection education
Counselling and education
Synovectomy
Tenosynovectomy
Tendon realignment
Reconstructive surgery or arthroplasty
Arthrodesis
Arthrodess
Arthrodesis is a surgical procedure stabilizing a joint by fusing the bones across the joint
Treatment of rheumatoid arthritis when symptoms present more than 6 weeks or antibody positive
PO Prednisolone 0.5-1mg/kg
and
Omeprazole or Esomeprazole
and
Diclofenac PO/Rectal or Celecoxib PO or Paracetamol PO
and
Calcium supplements
Arthroplasty
Arthroplasty is the surgical repair of a joint, replacing a part or all of a damaged joint with a prosthetic.
Tenosynovectomy
Tenosynovectomy is a procedure performed to surgically excise the tendon sheath (a layer of membrane surrounding the tendon)
Synovectomy
Synovectomy refers to the destruction or surgical removal of the membrane (synovium) that lines a joint
First line biologic DMARDs for rheumatoid arthritis according to STG
Hydroxychloroquine
Sulfasalazine
Methotrexate
Leflunomide
biologic synthetic DMARDS for rheumatoid arthritis
TNF - alpha inhibitors
Etanercept
Infliximab
Adalimumab
Golimumab
Cetorlizumab
Anti-CD20
Rituximab
Anti-CD80/86
Abatacept
IL-6 antagonist
Tocilizumab
IL-1 antagonist
Anakinra
targeted synthetic DMARDs or Janus kinase inhibitors for rheumatoid arthritis
Tofacitinib
Baricitinib
Upadacitinib
Second line agents for maintenance treatment of rheumatoid arthritis from STG
Cyclosporine
Azathioprine
Gold salts
D-penicillamine
Minocycline
