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
When might specialist tests be needed in RA?
To monitor extra-articular features e.g. Lung function tests
26
Why might joint aspiration be useful?
To rule out septic arthritis or crystal arthropathy
27
What does joint aspirate look like in RA?
Sterile cloudy fluid with raised polymorphs
28
What classification is used for RA?
ACR/EULAR | >= 6 - definite RA
29
What is the monitoring score for RA?
DAS28 (disease activity score)
30
What DAS score indicates remission?
<= 2.6
31
What DAS score indicates high disease activity?
>5.1
32
What DMARDs are used in RA?
Methotrexate Leflunomide Sulfasalazine Hydroxychloroquine
33
What are the management options in RA?
Symptom relief: NSAIDs, PT Acute flare: corticosteroids Long term: DMARDs, biologics
34
When are biologics used in RA?
If failed 2x DMARD | DAS28 > 5.1
35
What RA drugs are considered safe in pregnancy?
Sulfasalazine and hydroxychloroquine