Rheumatoid And Inflammatory Arthritis

Question 1

What are the two main divisions of Arthritis?

Answer 1

Osteoarthritis
Inflammatory arthritis

Question 2

Comment on the inflammation, speed of onset, synovial fluid analysis, CRP and WCC of degenerative, immune, crystal and septic arthritis

Answer 2

Question 3

What is the key investigation and management of septic arthritis?

Answer 3

Joint aspiration for gram stain and culture
Joint washout-lavage and IV antibiotics

Question 4

What is rheumatoid arthritis?
How does It present?

Answer 4

Autoimmune disease at synovium causing inflammation
Features: symmetrical polyarthritis, pain and swelling in morning around joints, autoantibodies in blood, lung disease, ocular inflammation, vasculitis leading to digital ischaemia, redness
Commonest affected joints metacarpophalangeal joints (MCP), Proximal interphalangeal joints (PIP), wrists, knees, ankles

Question 5

What are the risk factors of rheumatoid arthritis?

Answer 5

Smoking
Poor oral health
Microbiome
Genetics
Female sex

Question 6

What hand joints are affected in osteoarthritis?

Answer 6

Question 7

What are subcutaneous nodules?
What stage of rheumatoid arthritis is it most common in?

Answer 7

Fibrinoid necrosis surrounded by peripheral tissue
Only happens in severe rheumatoid arthritis
Typically in ulnar border of forearm and PIP

Question 8

How does the synovium change in RA?

Answer 8

Synovium becomes proliferated mass (PANNUS) due to inflammatory B and T cell, plasma cells, mast cells, activated macrophages, neurovascularisation

Question 9

What is the role of TNF-alpha in RA?
What does it cause?

Answer 9

Dominant pro-inflammatory cytokine in Rhuematoid synovium
Recruites autoimmune T and B cell- PANNUS formation
Loss of cartilage
Osteoclast activation- bone erosion
Inflammation
Joint space narrowing via cartilage degradation

Question 10

What are the investigations of RA?

Answer 10

Inflammatory response- check ESR, CRP
Autoantibodies- rheumatoid factor (bind to IgG) and Anti-CCP antibodies
RF isn’t RA specific so isn’t a diagnosing investigation, can be present in other autoimmune conditions

Question 11

How is RA treated?

Answer 11

Goal- prevent rather than goal
Physio
Glucocorticoid for acute but not long term- prednisolone but can cause Cushings if over used
Methotrexate (can give nodules) + hydroxychloroquine plus steroids
Monitor, if disease persists:
Anti-TNF alpha blockade (immunotherapy)
NSAIDS but not that effective

Question 12

What are the biological therapies for RA?

Answer 12

Anti-TNF-alpha
Anti-IL-6
Rituximab- antibody against Bcell antigen has to be regiven every 6-9 months as they repopulate
Abatacept- Blocks T cell stimulation- interferes with CD80 by binding to it on APC so it can’t bind to T cells CD28

Question 13

What is séronégative inflammatory arthritis?

Answer 13

Psoriatic arthritis
Ankylosing spondylitis
Reactive arthritis
IBD arthritis

Question 14

How does psoriatic arthritis present?

Answer 14

Asymmetrical IPJ
Enthesitis-inflammation on tendon insertions
Sometimes can be symmetrical- careful to not mix with RA
Spinal and sacroiliac joint inflammation- back

Question 15

What is Reactive arthritis?
What is it NOT the same as?
How does it present?
Should you give Antibiotics?

Answer 15

Autoimmune response to infection somewhere else in body, STERILE
No IV antibiotics needed unless there is an active infection
Common infections: Chlamydia, Salmonella, shigella
Enthesitis
Skin and eye inflammation
NOT SAME AS SEPTIC