Rheumatoid Flashcards
What are symptoms of Rheumatoid arthritis
Inflammatory arthropathy
Worse in the morning and gets better throughout the day
Symmetrical polyarthropathy
Avoids DIPJs
Extra articular features of RA
Carpal tunnel syndrome
Scleritis/Episcleritis
ILD - fibrosis
Effusions
Pericarditis
Feltys syndrome
SICCA /Sjogrens
Peripheral neuropathy
Nephrotic syndrome - secondary amyloidosis and membranous nephropathy, NSAIDS causing intersitial nephritis
Association with lymphoma/autoimmune diseases
Diagnostic criteria used
American college of rheumatology
How to score disease activity
DAS-28 (score of >5.1 - active disease)
X ray changes with RA
SPADES
Soft tissue swelling
Periarticular osteoporosis
Absent osteophytes
Deformity
Erosions
Subluxation
DMARDS in RA
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Biologics used in RA?
TNF-A - Adalimumab/infliximab
CD_20 - Rituximab
Check for Tb/Hepatitis/HIV before starting
Differential diagnosis for Ra
Psoriatic arthropathy
Enteropathic arthropathy
Gout/pseudogout
Inflam arthropathy assoc with SLE
Osteoarthritis
Investigations in RA
Bedside: Urine dip (nephrotic syndrome), ECG, obs
Bloods
TIER 1: FBC/RP/LFT/CRP/ESR/CLOTTING/TFTs
TIER 2:
RF (Igm to FC component IGG), Anti-CCP. HLA B27
Infective screen
IMAGING:
X ray of joints
How do you assess function on examination?
Ask to make a fist
Squeeze finger
Do up buttons
Write a sentence
What medication should you avoid with methotrexate
Trimethoprim
What are causes of anaemia in RA
anaemia of chronic disease
Bone marrow suppression
GI bleeding due to meds
AIHA
Feltys syndrome
What is swan neck deformity
Hyper extension of the PIPj
Flexion of the DIPJ
What is bouttonieres deformity
Flexion of the PIPJ
Extension of the DIPJ
Lung features of Rheumatoid arthritis
rheumatoid nodules
CTD related ILD
Pleural effusions
Bronchiolitis obliterans
What are side effects of methotrexate
Neutropaenia, pulmonary toxicity and hepatitis
Main side effect of hydroxychloroquine ?
Retinopathy
What side effects are associated with azathioprine
Bone marrow issues - leucopaenia
Pancreatitis
What features indicate a poor prognosis in RA
Seropositive disease (RF or Anti-CCP) - increased risk of extra articular features
HLA DR4
Female
