Rheumatoid Arthritis Flashcards
what type of inflammatory arthopathy is RA
seropositive
what joints are most commonly affected
small joints of hands and feet
when are larger joints affected
as disease progresses
are men or women more commonly affected
women (2-3 x’s)
what is the prevalence
1%
what is the peak age group
35-50
what percentage of risk factors do genetics contribute to
50%
how increased is a persons risk of developing RA if a first degree relative has it
2-3
what is the pathogenesis
immune response initiated against synovium lining synovial joint and some tendons,
inflammatory pannus forms which attacks and denudes articular cartilage leading to joint destruction,
tendon rupture and soft tissue damage can then occur
what are some potential triggers for initiating the immune response
smoking, infection or trauma
what does tendon rupture and soft tissue damage lead to
instability and subluxation
what is diagnosis based on
clinical presentation, radiographic findings and serological analysis
what criteria’s can aid diagnosis
ACR and EULAR
what are clinical features of RA
- symmetrical synovitis (doughy swelling)
- pain
- morning stiffness
- hands and feet in early stages
- MCP and PIP’s affected but DIP’s not
- wrists affected
what is a long term complication involving spine involvement
cervical spine
atlanto-axial subluxation resulting in cervical cord compression
what are some extra-articular manifestations
rheumatoid nodules, lung involvement, increased cardiovascular morbidity and mortality, ocular involvement
what percentage of patients tend to have rheumatoid nodules
25%
where are rheumatoid nodules usually found
extensor surfaces or sites of frequent mechanical irritation
what is usually present in lung involvement
pleural effusions, interstitial fibrosis and pulmonary nodules
what is present in ocular involvement
keratoconjunctivitis sicca, episcleritis, uveitis and nodular scleritis that may lead to scleromalacia
what are investigations
autoantibodies, CRP, ESR and plasma viscosity, X-ray
what are the 2 autoantibodies associated with RA
rheumatoid factor and anti-ccp
which autoantibody is more specific
anti-ccp
what percentage of patients with RA are seronegative (no positive autoantibodies)
15-20%
are X-rays a good test in early disease
no
often show no joint involvement
what can X-rays show in early stages
peri-articular osteopenia (bone thinning) and soft tissue swelling
what can X-rays show in later stages
periarticular erosions
what can ultrasounds be useful for detecting
synovial inflammation if clinical uncertainty
what is the target time period to have started DMARD’s by
3 months of symptom onset
treatment
symptom relief (analgesia, NSAID’s and steroids)
what is the first line DMARD
methotrexate
what is a negative of DMARDS
can be immunosuppressive and suppress bone marrow so increase infection risk
is blood monitoring required when using DMARD’s
yes
what is the criteria to prescribe biologics
DAS 28 score of >5.1 (means high disease activity)
what are the most common used biologics
anti-TNF alpha drugs
how are anti-TNF alpha drugs administered
injection
there is also an increased risk of infection with biologics, which in particular
TB
what are other institutions for therapies for RA
physio, occupational therapy, podiatry, orthotists
what is surgery used for
resistant disease to control pain from a particular joint or improve or maintain function
operations for RA
synovectomy, joint replacement, joint excision, tendon transfers, arthrodesis (fusion), cervical spine stabilisation
