Rheumatoid Arthritis

Question 1

Mediated by _____

Answer 1

HLA-DR4

Question 2

Potential Triggers?

Answer 2

Infections, stress, smoking

Question 3

Main structure involved?

Answer 3

Synovium.

leads to inflamed synovial membrane

Present in hand joints (excluding DIPs), wrists, elbows, shoulders, TMJs, knees, hips, ankle, feet.

*not present in spine!!! (excluding C1/C2)

Question 4

Pathophysiology:

Answer 4

Genetic factors + immune system abnormalities cause CD4 T cells, mononuclear phagocytes, fibroblasts, osteoclasts, and neutrophils.
B cells produce autoantibodies (ie, rheumatoid factors)

Question 5

Clinical features:

Answer 5

Pain and swelling in a symmetrical fashion.

Prolonged early morning stiffness.

Largely small joints of hands and feet.

Question 6

Clinical presentations:

Answer 6

PIP,MCP,wrist ,MTP synovitis.
Monoarthritis.
Tenosynovitis.
Trigger finger.
Carpal tunnel syndrome.
Palindromic rheumatism.
Systemic symptoms.
Poor grip strength.

Question 7

Extra-articular manifestations:

Answer 7

Lungs-Interstitial lung disease, pleural effusion, Rheumatoid nodules.

Heart-Pericarditis, pericardial effusions.

Neurology-Peripheral neuropathy, carpal tunnel syndromes.

Peripheral Rheumatoid nodules.

Cardiovascular disease.

Arterial leg ulcers.

Question 8

Autoantibodies:

Answer 8

Rheumatoid Factor
Anti-CCP antibodies

Question 9

Management:

Answer 9

Early, aggressive treatment with DMARDs -Disease-modifying anti-rheumatic drugs (methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide)
Steroids as bridging therapy and for flares only.