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Musculoskeletal > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

What type of arthritis is RA?

A

Inflammatory

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2
Q

Give some examples of inflammatory arthritis’ apart from RA.

A

seronegative spondyarthritides
reactive arthritis
lyme arthritis
crystal arthritis
postviral arthritis

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3
Q

At what time of day is RA worse?

A

In the morning

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4
Q

Does pain in the morning last longer in RA or OA?

A

RA

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5
Q

Is RA a symmetrical or asymmetrical condition?

A

Symmetrical

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6
Q

Does RA usually present as a monoarthritis or a polyarthritis?

A

Polyarthritis

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7
Q

When is the peak incidence of RA?

A

30-50

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8
Q

Is there a difference in incidence of RA between men and women?

A

Yes, women are more likely to be affected before menopause

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9
Q

What genes are associated with RA?

A

HLA-DR4 and HLA-DR1

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10
Q

What environmental factors are associated with RA?

A

Smoking, stress and infection

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11
Q

What is the progression of RA usually?

A

Weeks to months usually

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12
Q

What deformities might you see in the hands in RA?

A

Swan neck
Z thumb
Muscle wasting
Fixed flexion deformity (Boutonniere)
Ulnar deviation
Inflamed flexor tendon sheaths

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13
Q

Why might you get loss of sphincter control or unexplained weakness in late RA?

A

Due to spinal cord compression

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14
Q

In what sort of weather are RA symptoms worse?

A

Hot weather

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15
Q

What might patients with undiagnosed RA in their feet say it feels like?

A

Like they’re walking on marbles

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16
Q

What type of anaemia can you get in RA?

A

Normochromic. normocytic

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17
Q

What other autoimmune condition is closely related to RA?

A

Sjogren’s syndrome

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18
Q

What eye changes can you get in RA?

A

Dry eyes, episcleritis, scleritis, cataracts, uveitis, glaucoma

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19
Q

In what lobe can all connective tissue disorders cause pulmonary fibrosis except for AS?

A

The lower lobe

20
Q

In what lobe can all occupational tissue disorders cause pulmonary fibrosis except for asbestosis?

A

The upper lobe

21
Q

What pattern will you see on spirometry in pulmonary fibrosis?

A

Restrictive pattern

22
Q

What antibody is RF against?

A

IgG

23
Q

What is a case of RA referred to if there is no RF?

A

Seronegative RA

24
Q

What are the initial investigations you would do for RA?

A

FBC

25
Q

What might you see in blood tests for FBC?

A

Anaemia, raised inflammatory markers

26
Q

What might you see on serology in RA?

A

RF, ANA’ s and anti-CCP

27
Q

What might you see on x-ray later on in progression of RA?

A

Bony erosions and osteopenia

28
Q

What colour will joint aspirate be in RA?

A

Cloudy due to presence of white blood cells

29
Q

What is the main differential of RA?

A

SLE

30
Q

What is the aim of the management of RA?

A

To minimise damage to the joints

31
Q

What medication is used to provide symptomatic relief in RA?

A

NSAIDs

32
Q

What must be given to all patients over 65, and those with previous history of GI problems if they are given NSAIDs?

A

PPI

33
Q

What is used to help induce remission in RA?

A

Steroids

34
Q

What is the main risk in using steroids?

A

Osteoporosis

35
Q

What is the main therapeutic medication given in RA that helps to reduce functional impairment of joints?

A

DMARDs

36
Q

How long does it take DMARDs to take effect?

A

6-12 weeks

37
Q

How do most DMARDs work?

A

By inhibiting cytokines

38
Q

What type of drug is methotrexate?

A

Anti-folate drug

39
Q

What are the main side effects of methotrexate?

A

GI upset and mouth ulcers

40
Q

Why does NICE recommend methotrexate before anti-TNF?

A

It is cheaper but less effective

41
Q

What is an alternative medication to sulfasalazine in RA?

A

Leflonamide

42
Q

Why is hydroxycholoquine used in RA?

A

It is the least toxic but also has the least effect

43
Q

What should be done if someone is taking hydroxychloroquine?

A

Vision checks every 12 months

44
Q

What side effect can be caused by all DMARDs?

A

Myelosupression

45
Q

Which joints are almost never affected in RA?

A

distal interphalangeal joints

Musculoskeletal (2 decks)

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