Rheumatoid Arthritis Flashcards
What is rheumatoid Arthritis
Inflammatory autoimmune SYMMETRICAL poly arthritis
What are the RF for RA
Women 30-50 (Premeno)
Smoking
HLADR4/DRB1
What is the pathology of RA
Arginine to citruline mutation in T2 Collagen
Anti-CCP Formation
IFN-Alpha causes inflammation in Synovium
Synovial lining expands w/mass (Pannus)
Pannus destroys subchondral bone and articular cartillage
What amino acid mutation occurs in RA
Arginine to Citruline @ T2 collagen
What triggers IFN-Alpha to cause inflammation at Synovium
Anti-CCP Formation
What are the Presentations of RA
>30Min morning pain better through day HAND DEFORMITIES -Boutonniere -Swan neck -Z Thumb -Ulnar finger deviation Symmetrical, Hot inflamed joints
What are the 4 hand deformities found in RA
Boutonniers
Swan neck
Z Thumb
Ulnar finger deviation
How do the joints present typically in all RA
Hot Inflamed and symmetrical
In RA DIPJ is often spared, What differential is not DIPJ Sparing
Psoriatic Arthritis
Pencil in cup
What syndrome is RA a part of which causes life threatening risk of infection
Felty’s Syndrome
- RA
- Granulocytopenia
- Splenomegaly
What are the extra articular Sx of RA
PE and Pulmonary Fibrosis (Lungs) IHD Risk (Heart) Episcleritis /Keratoconjunctivitus sicca (Eyes) CKD (Kidney) Elbow nodules
What is Keratoconjunctiitus Sicca
Dry eyes
How is RA investigated
Bloods = Raised ESR/CRP w/ Normochromic/cytic anaemia
Serology. =Anti CCP and RF
X ray = LESS
What does the Xray show for RA (LESS)
Loss of joint space
Eroded bone
Soft tissue swelling
Soft bones (Osteopenia)
What blood markers are used to monitor RA progression
ESR and CRP
How is RA treated
DMARD = Methotrexate
NSAID = Analgesia
Steroid injection
Biologics (Infliximba/Rituximab)
What is the Gold standard treatment for RA
Methotrexate w/ Infliximab
What is the difference between Infliximab and Rituximab
Infliximab = TNF-Alpha blocker Rituximba = B cell inhibitor as CD20 target
What is the problem of methotrexate chronic use in RA
Inhibits folate so can cause Macrocytic anaemia
What are the genetic associations w/ RA
HLA DR4/DRB1
HLA DRB1
What is Felty’s syndrome
Triad of symptoms w/
Rheumatoid arthritis
Splenomegaly
Granulocytopenia
What is the list of investigations used in RA
Bloods
Anti CCP and RF
X Ray = LESS
What is the first line management of RA
Methotrexate and Infliximab
Why is Methotrexate contraindicated in Pregnancy
Inhibits Folate by inhibiting DNA synthesis
What type of drug is methotrexate
DMARD
What type of drug is Infliximab
Anti TNF Alpha inhibitor
What type of drug is rituximab
CD20 B cell inhibitor
What are the two eye features of RA
Episcleiritis
Keratojunctivitis Sicca
How is pain different in RA vs Osteoarthritis
Pain is better with use
What is A Baker’s cyst in RA
Popliteal sac buldge
What can be administered to support as an analgesic in RA
NSAID
What type of anaemia is commonly found in RA
Normocytic Normochromic of Chronic
What are the two main joints affected in RA
MCP and PIPJ
