rheumatoid arthiritis

Question 1

what is rheumatoid arthirits

Answer 1

Autoimmune disease
Joint inflammation

If untreated:
Joint destruction
Deformity
Loss of function
Extra-articular complications
Loss of employment
Increased mortality

Question 2

pathophysiology

Answer 2

genetic predisposition (HLA DR4) plus environmental precipitant (viral insult, bacteria, smoking)

Question 3

symptoms

Answer 3

Painful joints
Stiffness
EMS
Joint gelling
Swelling
Small joints > large joints
Symmetrical
Persistent

Question 4

investigations

Answer 4

Laboratory
Non-specific
CRP/ESR
FBC
Urate

Specific
RhF / CCP

Imaging
Plain radiograph
Ultrasound
MRI

Question 5

rheumatoid factors

Answer 5

IgM antibody
Directed against Fc portion of IgG Ab

Found in
RA
SLE
Sjogren’s
PBC
Hepatitis B & C
Bacterial endocarditis
Increasing age

Sensitivity around 70%
Specificity80-85%
5% of population without RA are positive

Question 6

CCP Ab

Answer 6

Inflammation leads to cellular damage
Enzymatic process leads to the conversion of arginine residues to citrulline

Alteration of shape creates a foreign antigen from self – anti citrullinated cyclic peptide antibodies.
Sensitivity66%
Specificity90%