Rheumatoid arthritis Flashcards
What type of arthritis is RA?
Inflammatory
Give some examples of inflammatory arthritis’ apart from RA.
seronegative spondyarthritides
reactive arthritis
lyme arthritis
crystal arthritis
postviral arthritis
At what time of day is RA worse?
In the morning
Does pain in the morning last longer in RA or OA?
RA
Is RA a symmetrical or asymmetrical condition?
Symmetrical
Does RA usually present as a monoarthritis or a polyarthritis?
Polyarthritis
When is the peak incidence of RA?
30-50
Is there a difference in incidence of RA between men and women?
Yes, women are more likely to be affected before menopause
What genes are associated with RA?
HLA-DR4 and HLA-DR1
What environmental factors are associated with RA?
Smoking, stress and infection
What is the progression of RA usually?
Weeks to months usually
What deformities might you see in the hands in RA?
Swan neck
Z thumb
Muscle wasting
Fixed flexion deformity (Boutonniere)
Ulnar deviation
Inflamed flexor tendon sheaths
Why might you get loss of sphincter control or unexplained weakness in late RA?
Due to spinal cord compression
In what sort of weather are RA symptoms worse?
Hot weather
What might patients with undiagnosed RA in their feet say it feels like?
Like they’re walking on marbles
What type of anaemia can you get in RA?
Normochromic. normocytic
What other autoimmune condition is closely related to RA?
Sjogren’s syndrome
What eye changes can you get in RA?
Dry eyes, episcleritis, scleritis, cataracts, uveitis, glaucoma
In what lobe can all connective tissue disorders cause pulmonary fibrosis except for AS?
The lower lobe
In what lobe can all occupational tissue disorders cause pulmonary fibrosis except for asbestosis?
The upper lobe
What pattern will you see on spirometry in pulmonary fibrosis?
Restrictive pattern
What antibody is RF against?
IgG
What is a case of RA referred to if there is no RF?
Seronegative RA
What are the initial investigations you would do for RA?
FBC
What might you see in blood tests for FBC?
Anaemia, raised inflammatory markers
What might you see on serology in RA?
RF, ANA’ s and anti-CCP
What might you see on x-ray later on in progression of RA?
Bony erosions and osteopenia
What colour will joint aspirate be in RA?
Cloudy due to presence of white blood cells
What is the main differential of RA?
SLE
What is the aim of the management of RA?
To minimise damage to the joints
What medication is used to provide symptomatic relief in RA?
NSAIDs
What must be given to all patients over 65, and those with previous history of GI problems if they are given NSAIDs?
PPI
What is used to help induce remission in RA?
Steroids
What is the main risk in using steroids?
Osteoporosis
What is the main therapeutic medication given in RA that helps to reduce functional impairment of joints?
DMARDs
How long does it take DMARDs to take effect?
6-12 weeks
How do most DMARDs work?
By inhibiting cytokines
What type of drug is methotrexate?
Anti-folate drug
What are the main side effects of methotrexate?
GI upset and mouth ulcers
Why does NICE recommend methotrexate before anti-TNF?
It is cheaper but less effective
What is an alternative medication to sulfasalazine in RA?
Leflonamide
Why is hydroxycholoquine used in RA?
It is the least toxic but also has the least effect
What should be done if someone is taking hydroxychloroquine?
Vision checks every 12 months
What side effect can be caused by all DMARDs?
Myelosupression
Which joints are almost never affected in RA?
distal interphalangeal joints
