Rheumatoid Arthritis Flashcards
What are the normal functions of the synovium?
- Maintenance of intact tissue surface
- Lubrication of cartilage
- Control of synovial fluid volume and composition (lubricin)
- Nutrition of chondrocytes within joints
What is RA?
Autoimmune condition causing chronic inflammation of the synovial lining (synovitis)
Is RA inflammatory or mechanical?
Inflammatory
Is RA symmetrical or assymetrical?
Symmetrical polyarthritis- Symmetrical and multiple joints
Is RA more common in men or women?
3 times more common in women
What is the pathology of RA?
- Thickened synovial lining which spreads across joint surface
- More production of synovial fluid
- Thinning of cartilage
- Erosion into corner of bone via activated osteoclasts
- Inflamed tendon sheath
What is Rheumatoid Factor?
RF is an autoantibody that detects the Fc portion of the IgG antibody
What are anti-CCP antibodies?
Autoantibodies that are more specific to RA than RF.
Often predate the development of RA
What are the features of RA?
Pain worse on rest and better on movement
Morning stiffness >30 minutes
Soft, boggy swelling
What are the systemic symptoms of RA?
Fatigue
Weight loss
Flu like illness
Muscle aches and weakness
What joints are commonly affected?
PIP joints
MCP joints
Wrist
Ankle
MTP joints
Cervical spine
What joints are never affected in RA?
DIP joints
- These are affected by OA (Heberden’s nodes)
What are the hand signs of RA?
Z shaped deformity in thumb
Swan neck deformity
Boutonnieres deformity
Ulnar deviation of fingers at MCP joints
What is swan neck deformity?
Hyperextended PIP with flexed DIP
What is Boutonnieres deformity?
Hyperextended DIP with flexed PIP
Due to a tear in the central slip of the extensor components of the fingers
What are some extra articular manifestations of RA?
Caplan’s syndrome- pulmonary fibrosis
Bronchiolitis obliterans
Anaemia of chronic disease
Secondary Sjogren’s syndrome
Rheumatoid nodules
Carpel tunnel syndrome
Amyloidosis
CVD
What investigations are done for RA?
Clinical signs
RF
Anti- CCP (if RF negative)
CRP, ESR, WCC
X ray of hands and feet
US - confirms synovitis
What X ray changes are seen in RA?
Joint destruction and deformity
Soft tissue swelling
Periarticular osteopenia
Bony erosions
What is the management of RA?
Steroids
NSAIDs (with PPI)
DMARDs
Biologics
Physiotherapy
Surgery
What are DMARDs?
Disease modifying anti-rheumatic drugs
- Methotrexate
- Sulfalazine
- Leflunomide
- Hydroxychloroquine
What are biologics?
Most advanced therapy available:
- Anti TNF: adalimumab, infliximab
- Anti CD20: rituximab
What is NICE guidance for medical treatment?
- Monotherapy- methotrexate, leflunomide or sulfasalazine
- Combination therapy- 2 DMARDs
- Methotrexate + biologic (TNF inhibitor)
- Methotrexate + rituximab
