Rheumatic Arthritis Flashcards
What is RA?
Chronic auto immune system illness characterised by symmetrical poly arthritis and other systemic features
Where does RA affect?
Most commonly the small joints of the hands, wrists and feet
What is the ration of females to males?
3:1
What is the typical age of onset?
4th/5th decade but may occur at any age from 16
What factors contribute to the aetiology?
Genetics
Environmental
Hormonal
How does genetic cause RA?
Rises 2-4% in sibling and 12-15% in monozygotic twins
Genetic contribution is estimated to be 50-60%
HLA-DRB1
Sequence of amino acids at postions 70 to 74 termed the shared epitope and consistent identified as a risk factor
What are environmental risk factors?
Cigarettes smoking
Chronic infection eg periodontal disease, EBV and parvovirus B19
What are hormonal risk factors?
Earl age at menopause
Low testosterone
What are symptoms?
Pain
Morning stiffness > 30 mins
Immobility
Poor function
Systemic symptoms
What are signs of RA?
Swelling
Tenderness
Warmth/ redness
Limitation of movement
What are non specific clinical signs of RA?
Fatigue/ lassitude
Weight load
Anaemia
What are specific clinical signs of RA?
Eyes, lungs, nerves, skin, kidneys
What are long term clinical signs?
CVS, malignancy
What are investigations for RA?
Baseline bloods
Immunology
Xray
Ultrasound
What blood investigations should be done?
FBC, kidney function, livers function, CRP and ESR
What immunology investigations should be done?
Rheumatoid factor
Anti cyclic citrullinated antibodies
What assessment should be done>
Disease activity score
What do different DAS scores show?
<2.6 represents clinical remission
>5.1 represents eligibility for biological therapy
What is the approach to management?
Early and aggressive intervention is the key to obtaining optimal outcomes
Effective suppression of inflammation will improve symptoms and prevent joint damage and disability
What are the different parts of management?
Pharmacological therapy
MDT
Management of flares
Surgery
What classes of drugs can be used for symptomatic treatment?
NSAIDS
-naproxen, ibuprofen, coxibs
GCs
-prednisone, prednisolone, hydrocortisone, dexamethasone
How to NSAIDs work?
Exert their pharmacological effect by inhibiting cyclooxygenase, especially COX-2
How do GCs work?
Complex mechanisms of anti-inflammatory and immunosuppresion effects
What are different disease modifying management?
Conventional, biological and targeted synthetic DMARDs
What are examples of conventional synthetic DMARDs?
Methotrexate, leflunomide, hydroxycholoroquine and sulfasalazine
How do csDMARDs work?
Non-targeted suppression of the overactive immune system
How do targeted synthetic DMARDs work?
Inhibitors with low selectivity, inhibiting the signalling of a broad range of cytokines
How do biologic DMARDs compare to transitional DMARDs?
Work rapidly
Well tolerated
Important toxicities
What are biologic classes?
TNFa inhibitors
IL-1 inhibitors
Anti B cell therapies
Anti T cell therapies
IL-6 inhibitors
Oral kinase inhibitors
What are issues with biologics?
Toxicity: minor eg injection site reaction
Increased risk of infection
Malignancy
Expensive
Who are part of the mdt?
Specialist nurse
Physiotherapist
OT
Podiatrist
Pharmacist
Psychologist
