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Rheumatology > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

8 week pain and stiffness. What is your differential diagnosis?

A

RA, psoriasis arthritis, OA, reactive arthritis, AI connective tissue disease

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2
Q

Which genes are associated with RA?

A

HLA DR4 and HLA DR1

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3
Q

What are the side effects of steroids?

A 
CUSHINGOID FAM
cushing's
ulcers
HTN
infectious
necrosis
growth restriction
osteoporosis
immunosuppression
diabetes
fluid retention
acute pancreatitis
myopathy
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4
Q

What is the management of RA?

A

pain relief
DMARD- steroids, methotrexatae + sulphasalazine, biologics
MDT_ physio, OT, podiatry

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5
Q

What are the side effects of methotrexate?

A

immunosuppression, bone marrow suppression, GI upset, hepatotoxicity

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6
Q

SE of sulphasalazine?

A

immunsuppression, bone marrow suppressiob, GI upset, hepatotoxicity, RASH

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7
Q

What is hydroxychloroquine used to treat?

A

RA

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8
Q

What are the SE of hydroxychloroquine?

A

generic: immunosuppression, bone marrow suppression, GI upset

Visual changes, skin

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9
Q

Which RA drugs are safe in pregnancy?

A

hydroxychloroquine and sulphasalazine

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10
Q

What are the components of a biologic screening?

A

CXR, TB test, HIV/hep B + C, VZV, FBC U+E LFT CRP

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11
Q

Which RA blood marker is highly specific?

A

Anti-CCP (RF is more sensitive but not as specific)

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12
Q

Explain a high CRP and low Hb in patient with RA

A

Anaemia of chronic disease- due to ongoing chronic inflammatory process= use up iron
CRP- transient protien that is realeased during active acute inflammation

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13
Q

Name two ocular complications associated with RA

A

scleritis and episcleritis

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14
Q

Name two blood tests to confirm RA

A

RF and anti-CCP

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15
Q

What is the treatment for RA?

A

NSAIDs, steroids, biological, DMARDs

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16
Q

Name four features of XR of RA

A 
loss of joint space
juxta articular osteopenia
subchondral cysts
periarticular erosion
soft tissue swelling
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17
Q

Define RA

A

Chronic systemic inflammatory disease characterised by

a symmetrical, deforming, peripheral polyarthritis.

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18
Q

What is the genetic association of RA?

A

HLA-DR4/DR1

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19
Q

State three specific deformities seen in RA

A
  1. Swan neck
  2. Boutonniere
  3. Z-thumb
  4. Ulnar deviation of the fingers
  5. Dorsal subluxation of ulnar styloid
20
Q

Three extraarticular features of RA?

A 
Nodules
Pericarditis
Carpal tunnel syndorome
Pleural effusion
Episcleritis
Sjorgen's syndrome
Raynaud's
Felty's syndrome
Vasculitis 
Lymphadenopathy
21
Q

Define felty’s syndrome

A

RA +splenomegaly + neutropenia

22
Q

Two tests that are highly specific to RA?

A

RF and anti-CCP

23
Q

Three investigations for RA?

A
  1. Bloods- FBC (anaemia, neutropenia), CRP
  2. RF +anti-CCP
  3. Radiography, US, MRI
24
Q

Discuss three aspects of medical management in RA

A
  1. DMARDs/biologics
  2. Steroids
  3. NSAIDs
  4. CV prevention
  5. Osteoporosis prevention
  6. Gastric ulcers prevention
25
Q

Prophylaxis for which condition must be managed in RA?

A

Cardiovascular events associated with athersclerosis

26
Q

List two DMARDs and provide one SE of each

A
  1. Methotrexate- hepatotoxic
  2. Sulfasalzine- hepatotoxic
  3. Hydroxychloroquine- retinopathy
27
Q

One side effect common in all DMARDs?

A

myelosuppression -> pancytopenia

28
Q

Two examples of biologics?

A

 Infliximab: chimeric anti-TNF Ab
 Etanercept: TNF-receptor
 Adalimumab: human anti-TNF Ab
 Rituximab (anti-CD20 mAb)

29
Q

Two side effects of biologics?

A

infection, autoimmune disease, cancer

30
Q

MOA of infliximab?

A

anti-TNF

31
Q

MOA of adalimumab?

A

anti-TNF

32
Q

Which sex is a risk factor for RA?

A

females

33
Q

What was the old classification for RA?

A

4/6 symptoms: morning stiffness, >2 joints, hand and wrist joints, rheumatoid nodules, RF positive (serology), and X-ray changes

34
Q

What is the most recent classification of RA?

A

presence of bilateral MCP or PIP joint enhancement on MRI

35
Q

How do sero-negative inflammatory arthropathies differ from RA?

A

normal bone density, periostitis, ankylosis (fusion), asymmetrical pattern

36
Q

Describe the pathophysiology of RA

A
  1. Initiation in the periphery 2. Propagation in the synovium 3. Tissue damage- bone and cartilage. Involves dysregulated inflammation with antigen presentationm T cell activation, and autoantibody production. Fibroblasts are activated, forming inflammatory panus. Activation of osteoclasts, leading to erosion of bone.
37
Q

In which other conditions is rheumatoid factor raised?

A

SLE, infection, increasing age

38
Q

One example of early RA stage you can see on XR?

A

peri-articular osteopenia, soft tissue swelling

39
Q

Two late stage examples of RA seen on XR?

A

erosion, joint destruction, subluxation/angulation

40
Q

Name two NSAIDs used in the treatment of RA?

A

ibuprofen, naproxen, diclofenac

41
Q

Which DMARD is teratogenic?

A

methotrexate

42
Q

Pregnant lady with RA, which DMARD?

A

sulfasalasine, hydroxychloroquine

43
Q

How can you monitor disease progession in RA?

A

DAS28= disease activity in 28 joints= scoring system.

44
Q

Three components of DAS28?

A

CRP/ESR, XR changes, pain, swelling, subjective assessment/questionnaire

45
Q

Which screening is conducted prior to biologic DMARD therapy

A

viral hep, HIV, varicella (chickenpox), CXR (TB), and vaccinations (influenza)

Rheumatology (19 decks)

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