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MSK lectures > Rheumatoid arthritis 08/10/18 > Flashcards

Rheumatoid arthritis 08/10/18 Flashcards

1
Q

What is Rheumatoid Arthritis?

A

Symmetrical inflammatory arthritis affecting mainly the peripheral joints

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2
Q

What can RA lead to if left untreated?

A

Joint damage
Irreversible deformities
Loss of function
Increased morbidity and mortality

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3
Q

What surfaces does RA affect?

A

Both articular and extra-articular

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4
Q

Which gender are more affected by RA?

A

Women x3

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5
Q

What is the mediator for RA?

A

HLA-DR4

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6
Q

What are potential triggers for RA?

A

Infections
Stress
Cigarette smoking

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7
Q

What does the severity of Ra depend on?

A

Genetic factors

Presence of autoantibodies

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8
Q

What is the main structure involved in RA?

A

The synovium

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9
Q

Where does the synovium line?

A

The inside of a synovial joint capsule and tendon sheaths

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10
Q

What spinal joints are synovium lined?

A

C1/C2

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11
Q

What are some joints that are lined with synovium?

A 
Hand joints
wrists
elbows
shoulders
TMJs
Knees
Hips 
Ankles
Feet
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12
Q

What cells are present in a pannus?

A 
Osteoclasts
Fibroblasts
Macrophage
Dendritic cell
T cell
Plasma cell
B cell
Extensive angiogenesis
Hyperplastic synovial lining
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13
Q

What is classified as early RA?

A

Less than 2 years since symptom onset

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14
Q

What is the 1987 criteria for RA?

A 
Morning stiffness
Arthritis of 3 or more joint areas
Arthritis of hands
Symmetric arthritis
Rheumatoid nodules
Serum RF
Radiographic changes
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15
Q

How is RA diagnosed?

A 
History and clinical examination
Blood testing 
Inflammatory markers
Autoantibodies
Imaging
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16
Q

what are the clinical features of RA?

A

Prolonged morning stiffness
Involvement of small hand a feet joints
Symmetric distribution
Positive compression tests of MCP and MTP joints

17
Q

What are the clinical features of RA?

A 
PIP,MCP,wrist ,MTP synovitis.
Monoarthritis.
Tenosynovitis.
Trigger finger.
Carpal tunnel syndrome.
Polymyalgia rheumatica.
Palindromic rheumatism.
Systemic symptoms.
Poor grip strength.
18
Q

What are the autoantibodies for RA?

A 
Rheumatoid factor (IgM) 
Anti-CCP antibodies
19
Q

What are the characteristics of Anti-CCP antibodies?

A

Can be present before articular symptoms
Associated with smoking
Remains positive despite treatment
Low sensitivity

20
Q

What is the imaging for RA?

A

Plain hand an feet X-rays
Ultrasound
MRI

21
Q

What can be seen on plain x-rays?

A

Soft tissue swelling
Periarticular osteopaenia
Erosions

22
Q

Why is ultrasound good imaging for RA?

A

Increased sensitivity for early disease
SUperior to clinical examination
Detects 7x MCP erosiosn

23
Q

What can MRI detect in RA?

A 
Bone marrow oedema
Integrety of tendons
Synovitis
Erosions
Disease activity
24
Q

What is the management for RA?

A 
Early recognition
Rheumatology care
Anti-rheumatic drugs
NSAIDs and steroids
Education
MDT
25
Q

What is the treatment pyramid for RA?

A 
NSAIDs
\+steroids
\+DMARD
\+DMARD2
\+DMARD3
Gradually withdraw treatments
26
Q

How are steroids used in RA?

A

Shown to improve symptoms
Combination with DMARDs
Orally IA or IM
Methylprednisolone

27
Q

What is a DMARD?

A

DISEASE MODIFYING ANTI-RHEUMATIC DRUGS-DMARDS

28
Q

Name three Dmards

A

Methotrexate
Sulfasalazine
Hydroxychloroquine

29
Q

What is the initial drug of choice in RA?

A

Methotrxate

30
Q

What is the dosage of methotrexate>

A

Start at 15 mg/week with rapid escalation
Maximum dose 25 mg/week
Folic acid 24 hours after MTX dose

31
Q

Are DMARDS safe in pregnancy?

A

No - Teratogenic

32
Q

What can go wrong with DMARDs?

A 
Regular monitoring needed.
Bone marrow suppression.
Infection.
Liver function derangement.
Pneumonitis in case of methotrexate.
Avoid Sulfasalzine in septrin allergy and G6PD deficiency
33
Q

What are some biological treatments that are used for RA?

A 
Anti TNF agents- Infliximab,Etanercept,Adalimumab,
Certolizumab,Golimumab
T cell receptor blocker-Abatacept.
B cell depletor-Rituximab
IL-6 blocker-Tocilizumab.
JAK 2 inhibitors-Tofacitinib.
34
Q

What are complications of untreated RA?

A

Boutonniere deformity of thumb
Ulnar deviation of MTP joints
Swan neck deformity of fingers

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