Rheumatoid Arthritis Flashcards
What type of arthritis is RA?
inflammatory, seropositive
What is inflammatory arthritis?
a group of conditions with joint of tendon inflammation, associated with abnormal bloods and imaging
Where is inflammatory arthritis common? bigger or smaller joints?
smaller
How does it commonly present?
pain and stiffness (common in the morning) in small joints, weaker grip, quick onset, swelling of affected joints, symmetrical
Who gets inflammatory arthritis?
any age group, women:men=3:1
What are triggers for inflammatory arthritis?
cigarettes, infections
What affects the severity and course of inflammatory arthritis?
genetics and presence of autoantibodies
What is the main structure involved in inflammatory arthritis?
synovium (lines joint capsules and tendon sheaths) makes direct contact with synovial fluid which acts as a lubricant
Name some synovial joints?
hand joints, wrist, elbows, shoulders, knees, hips, ankles, feet
What do susceptibility genes lead to?
conversion of amino acid arginine to amino acid citrulline this results in protein unfolding due to loss of positive charges the unfolded protein acts as an antigen
What is involved in the diagnosis?
history and clinical exam, inflammatory markers (CRP, ESR/Plasma Viscosity), autoantibodies, imaging
What are some main clinical features?
prolonged morning stiffness (>30 mins), involvement of small joints of hands and feet, symmetrical, positive compression tests of MCP and MTP joints
What are 2 autoantibodies?
rheumatoid factor, antibodies to cyclic citrullinated peptide
How sensitive and specific is rheumatoid factor?
sensitivity: 50-80%
specificity: 70-80%
How sensitive and specific is antibody to cyclic citrullinated peptide?
sensitivity: 60-70%
specificity: 90-99%
What autoantibody associated with disease activity, erosive damage and smoking?
Anti-CCP
Which autoantibody stays positive despite treatment?
Anti-CCP
When can X-rays detect disease?
usually later disease
What is ultrasound good for?
inc. sensitivity for synovitis in early disease. superior to clinical exam, detects MCP erosions more in early disease to X-rays, making treatment changes
When use MRI?
When diagnostic doubt as expensive
Treatment?
prompt diagnosis, early treatment with DMARDS, tight control to achieve remission or low disease activity, patient activity, MDT involvement
Advancements of treatment?
recognition of regular review, biologic agents
Examples of DMARDS
methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, combination therapy of 1,2 and 4, steroids (not long term)
Side effects of DMARDS?
bone marrow suppression, infection, liver function derangement, pneumonitis (common with methotrexate), nausea
