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rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

what is the management of rheumatoid arthritis during pregnancy?

A
  • hydroxychloroquine
  • sulfasalazine
  • folic acid
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2
Q

what is the scoring system used in rheumatoid arthritis?

A

DAS-28

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3
Q

how are DAS scores interpreted?

A
  • <2.6 = remission
  • 2.6-3.2 = low disease
  • 3.2-5.1 = moderate disease
  • > 5.1 = high disease
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4
Q

what part of the spine can rheumatoid arthritis affect?

A

cervical spine - particularly the atlanto-axis joint (C1-C2)

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5
Q

how do you assess c-spine involvement?

A

c-spine x-ray

typically requested pre-operatively

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6
Q

how do you assess c-spine involvement?

A

c-spine x-ray

typically requested pre-operatively

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7
Q

how does rheumatoid arthritis present?

A
  • symmetrical polyarthritis affecting the small joints of the hands and feet
  • typically spares the DIP joints
  • female
  • aged 40-50
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8
Q

what are the articular (joint) features?

A
  • symmetrical, polyarticular inflammatory arthritis
  • pain is better with movement
  • prolonged early morning stiffness (>30 mins)
  • joints are swollen, red, warm and tender
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8
Q

what are the articular (joint) features?

A
  • symmetrical, polyarticular inflammatory arthritis
  • pain is better with movement
  • prolonged early morning stiffness (>30 mins)
  • joints are swollen, red, warm and tender
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9
Q

what are the deformities seen on the hands in rheumatoid arthritis?

A
  • wrist subluxation
  • metacarpophalangeal (MCP) subluxation
  • swan-neck finger deformity
  • boutonniere finger deformity
  • ulnar deviation of proximal phalangers
  • z-shaped thumb
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10
Q

what is swan-neck finger deformity?

A
  • MCP flexion
  • PIP hyperextension
  • DOP hyperflexion
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11
Q

what is boutonniere finger deformity?

A
  • PIP flexion
  • DIP hyperextension
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12
Q

what are the deformities seen on the feet in rheumatoid arthritis?

A
  • hallux valgus
  • hammer toes
  • MTP subluxation
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13
Q

what does subluxation of the atlanto-axial joint present like?

A
  • neck pain radiating to the occiput
  • myelopathy - results in weakness and altered sensation in upper limbs
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14
Q

what is high-risk event in subluxation of the atlanto-axial joint?

A

migration of the odontoid peg through the foramen magnum
* spinal cord compression
* compression of the vertebral arteries
* sudden death

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15
Q

what are the peri-articular features in rheumatoid arthritis?

A
  • carpal tunnel syndrome
  • tenosynovitis
  • bursitis
16
Q

what is anti-CCP?

A

anti-cyclic citrullinated peptide autoantibodies

95% specific for RA

17
Q

what is the first-line treatment of choice in RA?

A

methotrexate

disease-modifying anti-rheumatid drugs (DMARDs)

18
Q

what medications can be added if RA is not well controlled on methotrexate?

A

second DMARD (e.g. sulfasalazine or hydroxychloroquine)

19
Q

what is bullseye maculopathy?

A

chloroquine maculopathy
* decline in visual acuity
* disturbances of colour vision
* small annular lesion in the macular area bilaterally

20
Q

what causes bullseye maculopathy?

A

hydroxychloroquine

21
Q

what is rheumatoid factor (RF) associated with?

A

more systemic involvement and a worse prognosis

22
Q

what antibodies are associated with RA?

A
  • anti-CCP (very specific)
  • RF
23
Q

what is felty’s syndrome?

A
  • rheumatoid arthritis
  • splenomegaly
  • neutropenia
24
Q

what is caplan’s syndrome?

rheumatoid pneumoconiosis

A
  • intrapulmonary nodules
  • rheumatoid arthritis
  • exposure to dust particles
25
Q

when should DMARDs be commenced?

A

within 3 months of the occurance of symptoms

26
Q

when are biologics considered in rheumatoid arthritis?

A

DAS >5.1 despite long-term combination DMARD therapy

27
Q

what biologics are typically used in RA?

A

anti-TNF agents (e.g. infliximab)

28
Q

what change in DAS score indicates no response to therapy?

A

change of <0.7

29
Q

what is a common haematological presentation of RA?

A

anaemia of chronic disease

30
Q

what are the x-ray findinds in RA?

A
  • soft tissue swellings
  • periarticular oestoporosis
  • juxta-articular erosions
  • narrowing of joint space
31
Q

what are the side-effects of methotrexate?

A
  • GI disturbance
  • folate deficiency - anaemia
  • immunosuppression
  • pulmonary fibrosis
  • liver toxicity
  • intersitital pneumonitis
  • rash
  • teratogenecity
32
Q

how long does a patient have to be off methotrexate before conception?

A

3 months

33
Q

what are the side-effects of sulfasalazine?

A
  • myelosuppression
  • nausea
  • rash
  • oral ulcers
  • decreased sperm count
34
Q

what are the side-effets of hydroxychloroquine?

A
  • retinopathy
  • rash
35
Q

what are the side-effects of biologic therapy?

A
  • immunosuppression
  • reactivation of TB
  • allergic reaction, reaction at infusion site
36
Q

what does joint aspiration show in rheumatoid arthritis?

A
  • high WBC count
  • predominantly polymorphic neutrophils (PMNs)
  • appearance = yellow and cloudy

rheumatology (9 decks)

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