Rheumathoid arthritis Flashcards
Define Rheumathoid arthritis
Polygenic autoimmune disease
Hallmark is synovial inflame that damages joints
HLADR1/4-predispose
Small joints, usual proximal finger joints, Wrists
Aetiology and risk factors of Rheumathoid arthritis
HLADR1/4-predispose
Role of citrullination-when Arg is deaminated-citruline
AB against cirtuline - big marker for RA (can be present very early, lot before RA)
and Rheumathoid factor-IgM against the constant part of IgG
Creates vicious cycle in joints of inflammation-drive osteoclasts
Risk factors Women Smoking Age-middle age FHx
Signs and Sx of Rheumathoid arthritis
BILATERAL Polyarthicular (lots), small joints Lots of stiffness in morning Suble joint swelling initially Tiredness MCP.PIP, Wrist joints
Tender joints
and feel spongy
after a bit : more signs-hope not to see them Swan neck -tip of finger v down Boutonniere-middle of finger down Z thumb-stuck in shape of Z Ulnar deviation at MCP Wrist dislocation
issues at atlanto-axial joint
Other/complications-Scleritis (very red eye) Interstitial lung disease-common Pericarditis Rheumathoid Nodules in elbow and vasculitis
FHx and Smoking
always want to PREVENT
Signs and Sx of Rheumathoid arthritis
BILATERAL Polyarthicular (lots), small joints Lots of stiffness in morning Suble joint swelling initially Tiredness MCP.PIP, Wrist joints
Tender joints
and feel spongy
after a bit : more signs-hope not to see them Swan neck -tip of finger v down Boutonniere-middle of finger down Z thumb-stuck in shape of Z Ulnar deviation at MCP Wrist dislocation
issues at atlanto-axial joint
Other/complications-Scleritis (very red eye) Interstitial lung disease-common Pericarditis Rheumathoid Nodules in elbow and vasculitis
FHx and Smoking
always want to PREVENT
Investigations of Rheumathoid arthritis
In early disease--nada Late-joint space narrowing Oestopenia Erosive damage-fluffy Joint deformity
when suspected CRP/ESR high Anti CCP present Rheum factor can or cannot Imaging studies by specialists--USS,MRI, baseline Xray DEXA scan
Management of Rheumathoid arthritis
always want to treat immediately-and refer as fast as possible
Analgesics, NSAIDS and IM steroids-that to control the pain and inflammation
and control the disease-reduce damage
DMARDs
Conventional, gold standard-Methotrexate (+folate)
Bio DMARD-TNF blockers-inflixumab, IL6 blockers
Complications of Rheumathoid arthritis
Other/complications-Scleritis (very red eye) Interstitial lung disease-common Pericarditis Rheumathoid Nodules in elbow and vasculitis
Prognosis of Rheumathoid arthritis
Used to be shit
But now with early and constant monitoring, with trying to shut it down-good
