rheumatoid arthritis

Question 1

what is

Answer 1

autoimmune condition that causes chronic inflammation of synovial lining of the joints

Question 2

pathophysiology of RA

Answer 2

rheumatoid factor is an autoantibody that presents in around 70% of RA patients. targets Fc portion of IgG antibody causes activation of immune system against patients own IgG
antiCCP antibodies too

Question 3

associated with what genes

Answer 3

HLA DR4
HLADR1

Question 4

pattern of pain in inflammatory disorders

Answer 4

worse after rest, better after activity

Question 5

presents with

Answer 5

symmetrical, usually multiple joints

women more than men, middle aged

pain
swelling- boggy feeling of joints
stiffness
poor function
warmth redness
limitation of movement
small joints of hands and feet and sometimes larger joints

fatigue
weight loss
flu like symptoms

can be overnight or gradual

Question 6

investigations

Answer 6

RF
antiCCP antibodies
must have one of these to diagnose. worse if anticcp

CRP and ESR
Xray of hands and feet. usually normal at beginning
US for synovitis. important for diagnosis

Question 7

treat with

Answer 7

NSAIDs or COX2i for flare ups with PPI

methotrexate
leflunomide
sulfasalazine
Hydroxychloroquine can be considered in mild disease and is considered the “mildest” anti rheumatic drug.
then 2 combo
then methotrexate plus anti TNFa eg infliximab
then methotrexate plus ritixumab

treat to target- titrate up
early and aggressive intervention is key
lots of check ups
MDT

Question 8

methotrexate side effects

Answer 8

bone marrow suppression
leukopenia
teratogenic

take folic acid too on different day from methotrexate. both once a week

Question 9

leflunomide side effects

Answer 9

peripheral neuropathy
teratogenic
hypertension

Question 10

sulfasalazine side effects

Answer 10

reduced sperm count

Question 11

risk factors

Answer 11

genetic
smoking
chronic infection
early age menopause
low testosterone in men
multifactorial

Question 12

what joints are not affected by RA

Answer 12

CMC joint
thoracolumbar spine

Question 13

Disease activity score

Answer 13

DAS28

based on the assessment for 28 joints and points are given for:

Swollen joints
Tender joints
ESR/CRP result

useful in monitoring response to treatment

if >5.1really bad- need biologics
if <2.6 clinical remission

Question 14

hydroxychloroquine side effects

Answer 14

Nightmares
Reduced visual acuity (macular toxicity)
Liver toxicity
Skin pigmentation

Question 15

Anti-TNF medications side effects

Answer 15

Reactivation of TB or hepatitis B