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MSK > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

Common chronic inflammatory autoimmune disease

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2
Q

What does rheumatoid arthritis involve?

A

Chronic inflammation of the synovial lining of the joints, tendon sheaths and bursa

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3
Q

Does rheumatoid arthritis tend to be symmetrical?

A

Yes

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4
Q

How does rheumatoid arthritis initially present?

A

A symmetrical, polyarticular inflammatory arthritis involving the small joints of the hands, wrists, and feet.

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5
Q

How can rheumatoid arthritis be differentiated from psoriatic arthritis?

A

The distal interphalangeal joints tend to be spared in rheumatoid arthritis and affected in psoriatic arthritis

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6
Q

Who is more commonly affected by rheumatoid arthritis?

A

Females
Smokers

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7
Q

What improves the pain in rheumatoid arthritis?

A

Movement

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8
Q

What can occur in the morning in someone with rheumatoid arthritis?

A

Prolonged early morning stiffness (more than 30minutes)

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9
Q

How can the joints appear on examination in someone with rheumatoid arthritis?

A

Joints are swollen, red, warm, and tender on examination.

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10
Q

What are 2 later signs of rheumatoid arthritis unlikely to be present on initial examination?

A

Swan neck
Boutonnière deformities

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11
Q

What test will be positive in someone with rheumatoid arthritis?

A

The squeeze test- discomfort on squeezing across the metacarpal or metatarsal joints

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12
Q

What are other possible presentations of rheumatoid arthritis?

A

acute onset with marked systemic disturbance
relapsing/remitting monoarthritis of different large joints

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12
Q

What are other possible presentations of rheumatoid arthritis?

A

acute onset with marked systemic disturbance
relapsing/remitting monoarthritis of different large joints

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13
Q

What is another term for relapsing/remitting monoarthritis of different large joints?

A

Palindromic rheumatism

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14
Q

What specific deformities of the hands are associated with rheumatoid arthritis?

A

Wrist subluxation.
Metacarpophalangeal (MCP) subluxation.
Swan-neck finger deformity
Boutonniere finger deformity
Ulnar deviation of proximal phalanges.
Z-shaped thumb.

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15
Q

What is swan neck deformity?

A

MCP flexion, PIP hyperextension, DIP hyperflexion

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16
Q

What is boutonniere finger deformity?

A

PIP flexion, DIP hyperextension

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17
Q

What specific deformities of the feet are associated with rheumatoid arthritis?

A

Hallux valgus.
Hammer toes.
MTP subluxation.

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18
Q

What early x-ray changes might you see in someone with rheumatoid arthritis?

A

loss of joint space
juxta-articular osteoporosis
soft-tissue swelling

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19
Q

What late x-ray changes might you see in someone with rheumatoid arthritis?

A

periarticular erosions
subluxation

20
Q

What other joints can be affected in someone with rheumatoid arthritis?

A

Cervical spine
(lumbar and thoracic spine are usually spared)

21
Q

Which part of the cervical spine is particularly affected in someone with rheumatoid arthritis?

A

Atlanto-axial joint (C1-C2).

22
Q

How is the Atlanto-axial joint affected?

A

Stabilising ligaments of the joint are damaged, instability and subluxation of the Atlanto-axial joint can occur

23
Q

What symptoms can Atlanto-axial subluxation result in?

A

Neck pain radiating to the occiput
Myelopathy resulting in weakness and altered sensation in the upper limbs

24
Q

What are the possible peri-articular features of rheumatoid arthritis?

A

Carpal tunnel syndrome
Tenosynovitis
Bursitis

25
Q

Where does tenosynovitis usually affect?

A

Flexor tendons in the hands, causing pain and swelling.

26
Q

Where does the bursitis usually occur in someone with rheumatoid arthritis?

A

Olecranon (elbow) and sub-acromial (shoulder) bursae

27
Q

Are patients with rheumatoid arthritis usually unwell?

A

Yes- Patients often feel generally unwell with RA, including low grade fevers, weight loss, and fatigue.

28
Q

What haematological conditions are associated with rheumatoid arthritis?

A

Anaemia of chronic disease- common
Splenomegaly- Felty’s syndrome
Amyloidosis
Generalised lymphadenopathy.

29
Q

What is Felty’s syndrome?

A

Triad of:
–Rheumatoid arthritis
–Splenomegaly
–Neutropenia

30
Q

What is the most common ocular manifestation of rheumatoid arthritis?

A

Keratoconjunctivitis sicca (dry eyes)
(other: Episcleritis and scleritis)

31
Q

What are the possible respiratory complications of rheumatoid arthritis?

A

Pulmonary fibrosis
Pleural effusions
Pulmonary nodules- Rheumatoid nodules
bronchiolitis obliterans-inflammation causing small airway destruction

32
Q

What is bronchiolitis obliterans?

A

Inflammation causing small airway destruction

33
Q

What respiratory complications can occur as a result of methotrexate?

A

Pneumonitis leading to pulmonary fibrosis

34
Q

What cardiac complications can occur as a result of rheumatoid arthritis?

A

Ischaemic heart disease
Pericardial effusion

35
Q

What is the first line antibody test for someone suspected of presenting with rheumatoid arthritis?

A

Rheumatoid factor

36
Q

What is rheumatoid factor?

A

Circulating antibody (usually IgM)

37
Q

How can rheumatoid factor be detected?

A

Rose-Waaler test

38
Q

If a patient is negative for RF, what should they be tested for?

A

Anti-cyclic citrullinated peptide antibody (anti-CCP)

39
Q

What is an advantage of testing for anti-CCP over RF?

A

Anti-CCP has a higher specificity for RA than RF

40
Q

What other conditions are associated with a positive RF?

A

Felty’s syndrome
Sjogren’s syndrome
infective endocarditis
SLE
systemic sclerosis

41
Q

What imaging should be carried out in all patients presenting with rheumatoid arthritis?

A

X-ray

42
Q

What is used for monitoring disease activity and response to treatment?

A

DAS28 score (Disease Activity Score)

43
Q

What is the DAS28 score based on?

A

The assessment for 28 joints and points are given for:
–Swollen joints
–Tender joints
–ESR/CRP result

44
Q

What is the diagnostic criteria for rheumatoid arthritis from?

A

American College of Rheumatology (ACR)

45
Q

What does the diagnostic criteria for rheumatoid arthritis involve?

A

The joints that are involved (more and smaller joints score higher)
Serology (rheumatoid factor and anti-CCP)
Inflammatory markers (ESR and CRP)
Duration of symptoms (more or less than 6 weeks)

46
Q

What features suggest a poor prognosis for rheumatoid arthritis?

A

rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset

47
Q

What are the 2 main genetic associations with rheumatoid arthritis?

A

HLA DR4
HLA DR1

MSK (79 decks)

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