Rheumatoid Arthritis Flashcards
what is the management of rheumatoid arthritis during pregnancy?
- hydroxychloroquine
- sulfasalazine
- folic acid
what is the scoring system used in rheumatoid arthritis?
DAS-28
how are DAS scores interpreted?
- <2.6 = remission
- 2.6-3.2 = low disease
- 3.2-5.1 = moderate disease
- > 5.1 = high disease
what part of the spine can rheumatoid arthritis affect?
cervical spine - particularly the atlanto-axis joint (C1-C2)
how do you assess c-spine involvement?
c-spine x-ray
typically requested pre-operatively
how do you assess c-spine involvement?
c-spine x-ray
typically requested pre-operatively
how does rheumatoid arthritis present?
- symmetrical polyarthritis affecting the small joints of the hands and feet
- typically spares the DIP joints
- female
- aged 40-50
what are the articular (joint) features?
- symmetrical, polyarticular inflammatory arthritis
- pain is better with movement
- prolonged early morning stiffness (>30 mins)
- joints are swollen, red, warm and tender
what are the articular (joint) features?
- symmetrical, polyarticular inflammatory arthritis
- pain is better with movement
- prolonged early morning stiffness (>30 mins)
- joints are swollen, red, warm and tender
what are the deformities seen on the hands in rheumatoid arthritis?
- wrist subluxation
- metacarpophalangeal (MCP) subluxation
- swan-neck finger deformity
- boutonniere finger deformity
- ulnar deviation of proximal phalangers
- z-shaped thumb
what is swan-neck finger deformity?
- MCP flexion
- PIP hyperextension
- DOP hyperflexion
what is boutonniere finger deformity?
- PIP flexion
- DIP hyperextension
what are the deformities seen on the feet in rheumatoid arthritis?
- hallux valgus
- hammer toes
- MTP subluxation
what does subluxation of the atlanto-axial joint present like?
- neck pain radiating to the occiput
- myelopathy - results in weakness and altered sensation in upper limbs
what is high-risk event in subluxation of the atlanto-axial joint?
migration of the odontoid peg through the foramen magnum
* spinal cord compression
* compression of the vertebral arteries
* sudden death
what are the peri-articular features in rheumatoid arthritis?
- carpal tunnel syndrome
- tenosynovitis
- bursitis
what is anti-CCP?
anti-cyclic citrullinated peptide autoantibodies
95% specific for RA
what is the first-line treatment of choice in RA?
methotrexate
disease-modifying anti-rheumatid drugs (DMARDs)
what medications can be added if RA is not well controlled on methotrexate?
second DMARD (e.g. sulfasalazine or hydroxychloroquine)
what is bullseye maculopathy?
chloroquine maculopathy
* decline in visual acuity
* disturbances of colour vision
* small annular lesion in the macular area bilaterally
what causes bullseye maculopathy?
hydroxychloroquine
what is rheumatoid factor (RF) associated with?
more systemic involvement and a worse prognosis
what antibodies are associated with RA?
- anti-CCP (very specific)
- RF
what is felty’s syndrome?
- rheumatoid arthritis
- splenomegaly
- neutropenia
