Rheumatoid arthritis Flashcards
What is rheumatoid arthritis?
Autoimmune condition causing chronic inflammation of the synovial lining of joints, tendons and bursa. It is normally symmetrical and affects multiple joints
What antibodies can be tested for that indicate rheumatoid arthritis?
Anti - CCP (cyclic citrullinated peptide)
Rheumatoid factor
How does rheumatoid arthritis typically present?
Symmetrical joint pain, swelling and stiffness
Is normally worse in the mornings and improves with activity
Systemic symptoms such as fatigue, weight loss, muscle aches
What joints are commonly affected by rheumatoid arthritis?
Small joints of the hands and feet.
Wrists and ankles
Cervical spine
Can also affect large joints such as the knees, hips and shoulders
What signs in the hands indicate rheumatoid arthritis?
Swan neck deformity
Boutonnieres deformity
Ulnar deviation of the knuckles
Z shaped deformity of the thumb
Describe swan neck deformity of the hand
Hyperextension of the PIP and flexion of the DIP.
Describe boutonniere deformity?
Flexion at the PIP and extension of the DIP
What is felty’s syndrome?
Triad of -
Rheumatoid arthritis, neutropenia and splenomegaly
What are the X-ray changes seen in rheumatoid arthritis?
Joint deformity
Bony marginal erosions
Soft tissue swelling
Periarticular osteopenia
What is the management for rheumatoid arthritis?
DMARDs (disease modifying anti-rheumatic drugs) such as methotrexate or sulfasalazine.
Steroids can be used in flare ups.
If still not controlled can add other medications such as a TNF inhibitor (infliximab) or rituximab.
Joint replacements - depending on severity and the joint effected
What are the risks of using biological therapies such as infliximab or rituximab?
Cause immunosuppression
Can cause reactivation of dormant infections (e.g. TB and Hep B)
