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Musculoskeletal > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What type of arthritis is rheumatoid arthritis?

A

Inflammatory arthritis

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2
Q

What are the associations with rheumatoid arthritis?

A 
~1% population
F:M = 3:1
HLA DR4, DR1 association
30-50yrs
Smokers
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3
Q

What is the pathogenesis of rheumatoid arthritis?

A

Inflammatory milieu –> synovial inflammation –> periarticular osteoporosis, bone & cartilage erosion –> progressive joint damage and destruction

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4
Q

What are the key players in rheumatoid arthritis and what is their relevance?

A

CD4+ T cells, Plasma cells, synoviocytes, macrophages, osteoclasts, IL-1, IL-6, IL-17, TNF alpha, IgG, IgM, RANK L
They are the targets for many treatments

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5
Q

What is the relevance of synoviocytes?

A

They can migrate between joints –> symmetrical presentation

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6
Q

What is the typical presentation of RA?

A

Symmetrical joint pain and swelling
Onset of pain over weeks - months
Early morning stiffness
Fatigue

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7
Q

What joints are commonly affected in RA?

A

Wrists, PIP, MCPs, MTPs

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8
Q

What may be seen on examination in RA?

A

Symmetric polyarthritis affecting small joints of the hand +/- deformity +/- extra-articular features
Joint swelling, tenderness

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9
Q

What signs may be present in RA?

A

Ulnar deviation
Swan neck deformity
Boutonniere deformity
Nodules

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10
Q

What systems may show extra-articular features in RA?

A 
Neuro
Haem
Eyes
Mouth
Lungs
Heart
Renal
Skin
Other
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11
Q

What is an important neurological extra-articular features of RA?

A

Cervical myopathy

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12
Q

What are the haematological extra articular features of RA?

A 
Anaemia of chronic disease
Neutropenia
Splenomegaly
Felty's syndrome
Large granular lymphocyte leukaemia
Lymphoma
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13
Q

What are the ocular extra-articular features of RA?

A

Keratoconjuncitivitis sicca
Episcleritis
Scleritis

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14
Q

What are the oral manifestations of RA?

A

Xerostomia

Peridontitis

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15
Q

What are the pulmonary manifestations of RA?

A 
Pleural effusions
Pulmonary nodules
Interstitial lung disease
Pulmonary vasculitis
Organising pneumonia
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16
Q

What are the cardiac manifestations of RA?

A 
Pericarditis
Ischaemic heart disease
Myocarditis
Cardiomyopathy
Arrhythmia
Mitral regurgitation
17
Q

What are the renal manifestations of RA?

A

Membranous nephropathy

Secondary amyloidosis

18
Q

What are the dermatological manifestations of RA?

A

Rheumatoid nodules
Purpura
Pyoderma gangrenosum

19
Q

What are some other extra-articular manifestations of RA?

A

Vasculitis
Osteoporosis
Hypoandrogenism

20
Q

What investigations are done for suspected RA?

A

Bloods: serology, FBC, inflammatory markers, U&Es, LFTs

21
Q

What serology is done in suspected RA?

A

Rheumatoid factor: antibody (IgM mostly) against Fc portion of IgG
Anti-CCP antibodies

22
Q

What may also raise rheumatoid factor?

A

Chronic infections - HCV, infective endocarditis

CTD - Sjogren’s, scleroderma, SLE

23
Q

What imaging is done for RA?

A

Xray
USS
MRI

24
Q

What may be seen in RA Xray?

A

Soft tissue swelling
Periarticular osteopenia
Joint space narrowing
Marginal erosion

25
Q

When might specialist tests be needed in RA?

A

To monitor extra-articular features e.g. Lung function tests

26
Q

Why might joint aspiration be useful?

A

To rule out septic arthritis or crystal arthropathy

27
Q

What does joint aspirate look like in RA?

A

Sterile cloudy fluid with raised polymorphs

28
Q

What classification is used for RA?

A

ACR/EULAR

>= 6 - definite RA

29
Q

What is the monitoring score for RA?

A

DAS28 (disease activity score)

30
Q

What DAS score indicates remission?

A

<= 2.6

31
Q

What DAS score indicates high disease activity?

A

> 5.1

32
Q

What DMARDs are used in RA?

A

Methotrexate
Leflunomide
Sulfasalazine
Hydroxychloroquine

33
Q

What are the management options in RA?

A

Symptom relief: NSAIDs, PT
Acute flare: corticosteroids
Long term: DMARDs, biologics

34
Q

When are biologics used in RA?

A

If failed 2x DMARD

DAS28 > 5.1

35
Q

What RA drugs are considered safe in pregnancy?

A

Sulfasalazine and hydroxychloroquine

Musculoskeletal (12 decks)

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