Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal Health > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What type of swelling occurs in inflammatory arthritis?

A

Boggy swelling - similar to when squashing a grape, this is suggestive of synovitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which joints are involved in rheumatoid arthritis?

A
  • Wrists
  • Metacarpophalangeal (MCP)
  • Proximal interphalangeal (PIPJ)
  • Involvement is usually symmetrical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which joints are involved in osteoarthritis?

A
  • PIPJ
  • DIPJ
  • Carpometacarpal phalangeal (CMPJ) - base of thumb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What deformities can RA patients develop?

A
  • Swan neck deformities: hyperextension of the PIPJ and flexion of DIPJ
  • Boutonniere deformity: flexion of PIPJ and hyperextension of DIPJ
  • Guttering: muscle wasting seen over dorsum of the hand
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What do you do if you suspect RA?

A
  • Prescribe analgesia for symptomatic relief
  • Refer them urgently to rheumatology
  • Rapid and aggressive suppression of inflammation improves long-term outcome by reducing joint damage, maintaining function and quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What investigations do you do for RA?

A
  • Baseline - FBC, LFTs, U+Es
  • Inflammatory markers to check levels of inflammation
  • Immunology: RF and anti-CCP antibody, also anti-nuclear antibody may indicate CTD
  • X-rays of swollen/painful joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is RF not diagnostic for RA?

A

RF is an immunoglobulin directed against the patient’s Fc portion of self IgG. It can present in the normal population, Sjorgren’s syndrome, other rheumatic conditions, certain malignancies and chronic infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the best test for the diagnosis of RA?

A

Anti-CCP antibodies have high sensitivity and specificity for RA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What x-ray changes can occur in established RA disease?

A
  • Periarticular erosions (juxta-articular)
  • Osteopenia
  • Joint space narrowing (usually uniform)
  • Deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why could the FBC be abnormal in RA?

A
  • Anaemia of chronic disease
  • IDA secondary to use of non-steroidals or other causes
  • Felty’s syndrome: anaemia, leucopenia and enlarged spleen
  • Pernicious anaemia: autoimmune diseases are more likely to have a 2nd one
  • Autoimmune haemolytic anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What other abnormalities could show up in baseline tests for RA?

A
  • Platelet count can go up due to inflammatory process
  • Raised LFTs
  • Raised ferritin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the target populations for testing for RA?

A
  1. Have at least 1 joint with definite clinical synovitis (swelling)
  2. With the synovitis, not better explained by another disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is the DAS28 score calculated?

A

Calculated from a composite of a joint tenderness score, no. of swollen joints, patient global assessment of disease activity and a measure of acute phase response (ESR or CRP).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the DAS28 score figures?

A

Remission <2.6
Low 2.6-3.2
Moderate 3.2-5.1
Severe >5.1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the extra-articular features of RA?

A
  • Carpal tunnel syndrome, peripheral neuropathy (mononeuritis multiplex), atlanto-axial subluxation (misalignment of 1st/2nd cervical vertebrae)
  • Palmar erythema, nail fold infarcts, ulceration
  • Pleural effusion, pleuritis
  • Pericardial effusion, pericarditis, nodules, ILD, PF
  • Vasculitis
  • Lymphadenopathy
  • Splenomegaly
  • Felty’s syndrome
  • Episcleritis, scleritis, scleromalacia perforans (corneal melt)
  • Keratoconjunctivits sicca (dry eyes and mouth)
  • Normochromic normocytic anaemia, leukopenia, pancytopenia
  • Amyloidosis
  • Fatigue, low grade fever, weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the first line treatment of RA?

A

DMARD monotherapy +/- a short course of bridging prednisolone. Monitor with CRP and DAS28 to assess response to treatment.

17
Q

What is the treatment for flares of RA?

A

Oral or intramuscular corticosteroids

18
Q

What DMARDs are used in RA?

A

Methotrexate is most common - monitor FBC and LFTs due to risk of myelo-suppression, liver cirrhosis and pneumonitis.
Also, there is sulfasalazine, leflunomide, hydroxychloroquine

19
Q

When are TNF-inhibitors used instead of DMARDs?

A

Inadequate response to at least 2 DMARDs including methotrexate. For example, etanercept, infliximab or adalimumab.

20
Q

What is synovitis?

A

The synovium becomes inflamed and thickened and proliferative synovitis (pannus) can be seen. Angiogenesis occurs so leucocytes accumulate, along with inflammatory cells e.g. macrophages, T cells etc. The synovial fluid becomes fibrinous inflammatory exudate, containing many neutrophils. Local release of matrix-degrading enzymes and inflammatory mediators can damage adjacent cartilage to form erosions.

21
Q

What is the presentation of RA?

A
  • Swollen, painful joints in hands and feet
  • Stiffness worse in the morning
  • Gradually gets worse with larger joints becoming involved
  • Presentation usually insidiously develops over a few months
  • Positive ‘squeeze test’ - discomfort on squeezing across the metacarpal or metatarsal joints
22
Q

What is the classification criteria for RA?

A

Score of >/= 6/10 in categories A to D

23
Q

What is the A group of symptoms for classifying RA?

A

Joint movement

  1. 1 large joint
  2. 2-10 large joints
  3. 1-3 small joints (*with or without involvement of large joints)
  4. 4-10 small joints (*)
  5. > 10 joints (at least 1 small joint)
24
Q

What is the B group of symptoms for classifying RA?

A

Serology (at least 1 test result needed for classification)

  1. Negative RF and ACPA
  2. Low-positive RF or low-positive ACPA
  3. High-positive RF or high-positive ACPA
25
Q

What is the C group of symptoms for classifying RA?

A

Acute-phase reactants (at least 1 needed for classification)

  1. Normal CRP and normal ESR
  2. Abnormal CRP or abnormal ESR
26
Q

What is the D group of symptoms for classifying RA?

A

Duration of symptoms

  1. <6 weeks
  2. > /= 6 weeks
27
Q

How would Felty’s syndrome present?

A

Splenomegaly causing neutropenia/pancytopenia

Musculoskeletal Health (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions