Rheumatoid Arthiritis - Week 6 PBL Flashcards
Presentation of RA?
Painful stiff swollen joints
Morning stiffness >30 mins
Pos MCP/MTP squeeze test
PIPs and MCPJ
Cericval spine and Hallux valgus in feet
Swan neck deformity
Boutonnières
Ulnar deviation
Risk factors of RA?
Other autoimmune diseases
Family history
Female
Smoking
HLA DRB1
HLA DRB4
X-ray features for RA?
LOSE
Loss of joint space
Osteopenia
subcondral cysts
erosions
Investigations for RA?
anaemia of chronic disease
Raised WCC
Neutrophillia
Inflammatory markers (CRP/ESR)
Autoantibodies: RF, ANA, anti- CCP
Extra articular manifestations of RA?
Lung - fibrosis, effusions, nodules, pneumonia
Ocular - dryness, episcleritis
Blood - anaemia, Feltys syndrome
Pericarditis
Management of RA?
Analgesia, physio
NSAIDS and steroids
Biologics: DMARDS (methotrexate) and bridge with corticosteroids
Flares: oral, IM corticosteroids
Non-Biologics, Resistant: TNF alpha inhibitors, etanercept or rituximab
How to monitor appropriate drug mange ent of RA?
CRP levels and DAS28
Types of RA medications?
NSAIDs - ibuprofen, naproxen,
DMARDS- methotrexate, sulfasalazine , hydroxychloroquine, leflunomide (combined therapy)
Biologics - adalimumab, etanercept and infliximab
Must give folic acid with methotrexate
Pathophysiology of RA?
Loss of tolerance to citruilline
T helper and B cells activated release RF and anti CCP
Why does RA affects many systems not just joints?
The anti CCPs immune response system occurs in most cells
What does the DAS 28 score involve?
Swollen joints
Tender joints
ESR
Global assessment of health
28 joints
Doesn’t involve feet as a con
What does methotrexate do?
Dihydrofolate reductase inhibitor
