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Finals: Medicine > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Which of the blood test is most specific for rheumatoid arthritis?

A

Anti-cyclic citrullinated peptide (Anti CCP) is the most specific blood test for rheumatoid arthritis (RA) with a specificity of ~96%

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2
Q

Define rheumatoid arthritis

A

Autoimmune condition that causes chronic, systemic inflammation affecting multiple joints leading to chronic joint pain, swelling and stiffness

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3
Q

What is the genetic risk factor for rheumatoid arthritis

A

HLA DR4/DR1

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4
Q

Name some of the risk factors for rheumatoid arthritis

A

Combination of environmental and genetic

Presence of HLA DR4/DR1 gene

Women gender

Smoking

Family history

Note it is more common in middle age but can develop at any age

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5
Q

Name the two antibodies associated with rheumatoid arthritis

A

Rheumatoid Factor (RF)

Cyclic citrullinated peptide antibodies (anti-CCP antibodies)

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6
Q

Rheumatoid Factor (RF) and Cyclic citrullinated peptide antibodies (anti-CCP antibodies) are the two autoantibodies associated with rheumatoid arthritis.

Which is more sensitive and specific for rheumatoid arthritis

A

Cyclic citrullinated peptide antibodies (anti-CCP antibodies)

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7
Q

Patients with rheumatoid arthritis usually present with a history of bilateral, symmetrical pain and swelling of the small joints of the hands and feet.

How long is this pain usually lasted for

A

> 6 weeks

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8
Q

What in the body is commonly affected in rheumatoid arthritis

A

Small joints of the hands and feet

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9
Q

The pain and swelling of the joints associated with rheumatoid arthritis is what:

a) worse in the morning
b) worse at night

A

a) worse in the morning

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10
Q

The pain and swelling of the joints associated with rheumatoid arthritis is what:

a) worse after rest and improves with activity
b) worse with activity and improves with rest

A

a) worse after rest and improves with activity

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11
Q

Rheumatoid arthritis is associated with extr-articular manifestations.
Name some of these clinical features

A

Myalgia (muscle aches and pain)

Fatigue

Low-grade fever

Weight loss

Depression

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12
Q

Name 3 signs associated with rheumatoid arthritis

A

Synovitis (swollen and tender joints)

Deformities e.g. Swan neck deformity

Rheumatoid nodules

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13
Q

What test can be used to determine the presence of synovitis (a sign of rheumatoid arthritis)

A

Positive ‘squeeze test’ - discomfort on squeezing across the metacarpal or metatarsal joints

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14
Q

Name the four types of deformities associated with rhuematoid arthritis

A

Swan-neck deformity

Boutonniere deformity

Ulnar deviation at MCPs

Z-deformity at wrist

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15
Q

Describe the pathogenesis of swan neck deformity (seen in rheumatoid arthirits)

A

Hyperextension at the PIP joint

Flexion of the DIP joint

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16
Q

Describe the pathogenesis of Boutonniere deformity (seen in rheumatoid arthirits)

A

Flexion at the PIP joint

Hyperextension DIP joint

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17
Q

Describe the pathogenesis of ulnar deviation (deformity seen in rheumatoid arthirits)

A

Subluxation of the MCP joints with deviation of the fingers towards the ulnar bone

18
Q

Describe the pathogenesis of Z-deformity (deformity seen in rheumatoid arthirits)

A

Hyperextension of interphalangeal joint of thumb (IP)

Hyperextension of metacarpophalangeal joint (MP)

Flexion of CMC joint

19
Q

What are Extra-articular manifestations

A

Systemic clinical manifestations involving other organ systems

20
Q

Extra-articular manifestations occur in 40% of patients with rheumatoid arthritis.

Name an ocular manifestation

A

Episcleritis: inflammation of superficial layer of sclera

21
Q

Extra-articular manifestations occur in 40% of patients with rheumatoid arthritis.

Name an mouth manifestation

A

Oral ulcers

22
Q

Extra-articular manifestations occur in 40% of patients with rheumatoid arthritis.

Name an pulmonary manifestation

A

Interstitial lung disease

Serositis (inflammation of the serous membranes i.e. pleural, pericardium, peritoneum)

23
Q

Extra-articular manifestations occur in 40% of patients with rheumatoid arthritis.

Name an cardiac manifestation

A

Pericarditis (inflammation of the pericardium)

Myocarditis (inflammation of the myocardium)

24
Q

How is rheumatoid arthritis diagnosed

A

Clinical diagnosis

25
Q

Once a clinical diagnosis of rheumatoid arthritis is made, several laboratory tests help to determine prognosis.

Name a laboratory test can help determine prognosis

A

Antibody tests e.g. RF, anti CCP

Inflammatory markers (CRP; ESR)

26
Q

Name an imaging modality that can be useful in investigating rheumatoid arthritis

A

X-ray

Ultrasound scan of the joints (confirm synovitis)

27
Q

What are the X-ray features of rheumatoid arthritis

A

“PJ Look Smart”

P – Periarticular erosions (red arrow)

J – Juxta-articular osteoporosis (green circle)

Look – Loss of joint space (yellow, blue arrows)

Smart – Subluxation

Juxta-articular meanings near a joint

28
Q

What is the aim of rheumatoid arthritis management

A

To induce and then maintain remission

29
Q

What two things are used to monitor the success of treatment for rheumatoid arthritis

A

CRP

AND

DAS28

30
Q

What is DAS 28

A

Scoring measuring the disease activity in rheumatoid arthritis

DAS stands for ‘disease activity score’

28 refers to the 28 joints that are examined in this assessment (examined for tenderness and swollen)

31
Q

What is the initial management/flare up management of rheumatoid arthritis

A

Short course of corticosteroids

NSAIDs/COX-2 inhibitors are often effective but risk GI bleeding so are often avoided or co-prescribed with PPI

32
Q

What is the 1st line medication used to induce remission in rheumatoid arthritis

A

Disease Modifying Anti-Rheumatic Drugs (DMARDs) - typically methotrexate

33
Q

What is the second line management for inducing remission in rheumatoid arthritis

A

Two DMARDs used in combination

34
Q

What is the third line management for inducing remission in rheumatoid arthritis

A

Methotrexate plus a biological therapy

35
Q

What is the fourth line management for inducing remission in rheumatoid arthritis

A

Methotrexate plus rituximab

36
Q

Why are steroids given with Disease Modifying Anti-Rheumatic Drugs (DMARDs) for the first 2-3 months

A

Bridging to allow time for the DMARD to take effect

37
Q

What must be given along with methotrexate

A

Folic acid

38
Q

What drug class is methotrexate

A

Disease modifying anti-rheumatic drug (DMARD)

39
Q

Why are FBC and LFTs monitored when given methotrexate

A

Risk of myelosuppression and liver cirrhosis

40
Q

What is the most common biological therapy (used in the third line therapy for remission of rheumatoid arthritis)

A

TNF inhibitor e.g. infliximab

41
Q

What drug class is rituximab (used as a fourth line therapy for remission of rheumatoid arthritis)

A

Biological therapy

Causes B cell depletion

Finals: Medicine (91 decks)

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