Rheumatoid Arthritis Flashcards
What is the pathogenesis of RA?
Citrullination of self antigens - recognised by T and B cells and produce RF and anti-CCP antibodies. Stimulation of macrophages and fibroblasts that release TNF-alpha. Inflammatory cascade leads to synoviocyte proliferation (soft tissue swelling) and macrophages also stimulate osteoclast differentiation (bone damage)
What is the typical history for RA?
Female 3:1
30-50 years old
Progressive, peripheral and symmetrical polyarthritis
Affects MCPs, PIPs, MTPs but can affect any joint
6 weeks or more morning stiffness lasting more than 30 minutes
Fatigue/malaise
What is found on examination of RA?
- Soft tissue swelling and tenderness
- Ulnar deviation/palmar subluxation of MCPs
- Swan neck/Boutonniere deformity of digits
- Rheumatoid nodules (commonly on elbow)
- Carpal tunnel association
What investigations would you do for RA? And what would be the findings?
- Autoantibodies - RF and anti-CCP
- FBC - normocytic anaemia (anaemia of chronic disease)
- WCC if concerned about septic arthritis
- Inflammatory markers - raised
- X-Ray - loss of joint space, periarticular erosions, soft tissue swelling and subluxation/USS/MRI
- Other investigations based on history and exam e.g. PFTs if lung involvement
What is the treatment for RA?
- DMARDs (monotherapy, or combination if needed) - usually methotrexate
- In acute flares - oral steroids
- Symptom control with NSAIDs
- If still severe disease - consider biologics
- OT/PT, podiatry and psychological
Does RF+ relate to disease severity?
Yes and usually have extra-articular manifestations as well
Extra-articular manifestations of RA can be split as 3Cs, 3As, 3Ps and 3Ss - what are these?
- Carpal tunnel syndrome, elevated cardiac risk (CVD) and cord compression
- Anaemia (normocytic and normochromic), amyloidosis, Arteritis
- Pericarditis, pleural disease and pulmonary disease
- Sjogren’s, scleritis/episcleritis, splenic enlargement
