rheumatoid arthritis

Question 1

what is the pathology of RA?

Answer 1

T- helper cells and macrophages accumulate in the synovium - forms a pannus
pannus erodes and articular cartilage and entheses become inflamed due to effusion
macrophages express antigen peptides on HLA II which activated T-helper cells that release il-1 and TNF
these cytokines causes: chemotaxis of leucocytes, excess synovial fluid, cartilage destruction, bone resorption, RF and anti-CCP from B cells

Question 2

what is pannus?

Answer 2

layer of inflamed tissue made of macrophages and osteoclasts

Question 3

what are the articular features of RA?

Answer 3

symmetrically effects medium and smaller joints
pain/stiffness for over an hour in the morning
effects MCP. PIP, DIP
metatarsal head erosions and valgus deformity (in foot)
atlanto-axial subluxation, radiated pain to acciput (in cervical spine)

Question 4

what are the extra-articular features of RA?

Answer 4

rheumatoid nodules
tenosynovitis and buritis
carpal tunnel syndrome
systemic - weight loss, lethargy, fever
eyes- keratoconjunctivitis, scleritis, episcleritis
lungs - pulmonary fibrosis, effusion
heart - myocarditis, pericarditis, coronary aretitis

Question 5

what investigation is done for RA?

Answer 5

x-ray
MRI to identify synovitis
bloods - FBC (anaemia, thrombocytosis), ESR raised, CRP raised, RF positive, anti-CCP

Question 6

what is seen on an x-ray in RA?

Answer 6

soft-tissue swelling
osteopenia
erosions
narrowing joint spaces

Question 7

what drugs are given for RA?

Answer 7

NSAIDs
corticosteroids (intramuscular or intraarticular)
DMARDs
biologics (if 2 failed DMARDs and DAS score over 3.2)

Question 8

what is the age of onset for RA?

Answer 8

40-60

Question 9

what factors affect developing RA?

Answer 9

genetic - HLAB27
environmental - smoking