Rheumatoid Arthritis

Question 1

Definition

Answer 1

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease. Early RA is defined as disease duration of 5 years or less from the onset of symptoms.

Question 2

Prevalence

Answer 2

About 1% of the Uk population

Question 3

Presentation

Answer 3

• Persistent synovitis lasting weeks
• Pain, swelling, heat in joints
• Early morning stiffness
• Pain worse on rest
• nodules over extensor surfaces
• Systemic features e.g. malaise, fatigue, fever, sweats, weight loss

Question 4

Pathophysiology

Answer 4

when there is an imbalance of anti-inflammatories (IL-4, TGF-b) and pro-inflammatory (IL-1, IL-6, TNF-a) in the body

Question 5

Investigations

Answer 5

Carry out blood test for Rheumatoid factor and anti-CCP antibodies

Also may do FBC, LFTs, renal tests to help treat other symptoms

Question 6

Management

Answer 6

Refer to rheumatology urgently
Offer NSAIDs in meantime (ibrupofen, naproxen, celecoxib)

Question 7

Differentials (6)

Answer 7

SLE
Fibromyalgia
Septic arthritis
Osteoarthritis
Gout
Psoriatic arthritis

Question 8

What is the scoring system for RA?

Answer 8

DAS - disease activity score
Below 2 - remission
2-3 - low disease activity
3-5 - moderate DA
above 5 - high DA

Question 9

Which area of the spine does RA affect the most commonly

Answer 9

Cervical Spine - lumbar and thoracic are usually spared