Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis?
Chronic, Inflammatory autoimmune polyarthritis
Does it affect only one side of the body or both?
Both
Symmetrical
Risk factors of rheumatoid arthritis?
Women 30-50 (3x more likely than M pre-menopause - after menopause F=M)
Smoking
HLA DR4/DRB1 genetic link
What in the risk factors causes rheumatoid arthritis?
Interaction between genetic factor (HLA) and environment (Cig smoke) - Modifies self antigens
Pathology of rheumatoid arthritis
Citrullination takes place
Alters T2 collagen by mutation - Arginine (in T2 col) –> Citrulline (+ HLA RF) = Immune response
- Anti CCP (cyclic citrullinated peptide) forms (no longer recognised as self)
IFN alpha causes further pro inflammatory recruitment to synovium
Synovial lining expands, tumours like mass (Pannus) grows past joint margins
Pannus destroys subchondrial bone + articular cartilage
Pathology summed up
IFN alpha - Inflammatory response - increased synovial cells - pannus - damages cartilage + erodes bone
Symptoms of rheumatoid arthritis
Often worse in morning (~30 mins), eases as day goes on
Symmetrical, hot, inflamed joints
Hand = Boutonniere, swan neck, Z thumb, Ulnar finger deviation
Knee joint = Bakers cyst - popliteal synovial sac bulge
Symptoms of rheumatoid arthritis
Often worse in morning (~30 mins), eases as day goes on
Symmetrical, hot, inflamed joints
Hand = Boutonniere, swan neck, Z thumb, Ulnar finger deviation
Knee joint = Bakers cyst - popliteal synovial sac bulge
Where is rheumatoid arthritis most commonly found in body?
Wrist/hand
feet
What are some extra articular complications?
(increased risk of atherosclerosis)
Lungs - PE, Pul fibrosis
Heart - High IHD
Eyes - episcleritis, dry eyes
Spinal Cord compression
Kidney - CKD
Skin - Rheumatoid skin nodules - usually at elbows
Diagnosis of rheumatoid arthritis
tests and results
Bloods = High ESR/CRP, normocytic normochromic anemia (mc - chronic disease)
Serology = +ve Anti CCP (80%, specific)
+ve Rheumatoid factor (RF) (70%, non specific)
X ray = LESS
Loss of joint space
Eroded bone
Soft tissue swelling
Soft bones (osteopenia)
What other types of anemia can be caused by rheum arthritis?
Microcytic
NSAID use –> PUD –> Fe def anemia
Macrocytic
Methotrexate use - inhibits folate
Treatment of rheumatoid arthritis
DMARD (Disease modifying anti rheumatic med) - METHOTREXATE, sulfalazine, Leflunomide
NSAIDS, Analgesia, Prednisolone (glucocorticoid - anti inflam steroid), Steroid injection (if v painful)
Biologics = very good but expensive
1st line - (given with methotrexate) TNF alpha inhibitor = INFLIXIMAB
2nd line = B cell inhibitor (target CD20) - RITUXIMAB
what is the CI of methotrexate?
Pregnancy
folate inhibitor, DNA synthesis affected
What Is the gold standard treatment given?
Methotrexate given with biologic
