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MRCP Rheumatology > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

Respiratory manifaestations of RA

A

pulmonary fibrosis
pleural effusion
pulmonary nodules
bronchiolitis obliterans methotrexate pneumonitis
pleurisy

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2
Q

Ocular manifestations of RA

A

keratoconjunctivitis sicca (most common)
episcleritis/ scleritis
corneal ulceration
keratitis
steroid-induced cataracts
chloroquine retinopathy

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3
Q

Complications associated with RA

A

osteoporosis
ischaemic heart disease
risk of infections
depression

Less common:
Felty’s syndrome (RA + splenomegaly + low white cell count)
amyloidosis

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4
Q

RA + splenomegaly + low white cell count

A

Felty’s syndrome

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5
Q

Criteria which increase likelihood of RA diagnosis

A

Multiple joints affected
positive anti-RF and anti-CCP
high inflammatory markers
Symptoms persisting >6 weeks

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6
Q

Which drug has the following side effects?

Myelosuppression
Liver cirrhosis
Pneumonitis

A

Methotrexate

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7
Q

Which drug has the following side effects?

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

A

Sulfasalazine

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8
Q

Which drug has the following side effects?

Liver impairment
Interstitial lung disease
Hypertension

A

Leflunomide

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9
Q

Which drug has the following side effects?

Retinopathy
Corneal deposits

A

Hydroxychloroquine

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10
Q

Which drug has the following side effects?

Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts

A

Steroids

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11
Q

Which drug has the following side effects?

Proteinuria

A

Gold

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12
Q

Which drug has the following side effects?

Proteinuria
Exacerbation of myasthenia gravis

A

Pencillamine

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13
Q

Which drug has the following side effects?

Demyelination
Reactivation of tuberculosis

A

Etanercept

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14
Q

Which drug has the following side effects?

Reactivation of tuberculosis

A

Infliximab/ Adalimumab

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15
Q

Which drug has the following side effects?

Infusion reactions are common

A

Rituximab

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16
Q

Which drug has the following side effects?

Bronchospasm in asthmatics
Dyspepsia/peptic ulceration

A

NSAIDs

17
Q

Tests used to detect Rheumatoid factor (RF)

A

Rose-Waaler test: sheep red cell agglutination
Latex agglutination test

18
Q

What percentage of patients with RA are positive for RF

A

70-80%

19
Q

RF is considered a marker of RA disease activity. TRUE/FALSE?

A

FALSE

20
Q

Other conditions in which RF is positive

A

Felty’s syndrome
Sjogren’s syndrome
infective endocarditis
SLE
systemic sclerosis
general population ~5%
rarely: TB, HBV, EBV, leprosy

21
Q

Sensitivity and specificity of Anti-CCP

A

Sensitivity ~ 70%
Specificity ~ 90-95%.

22
Q

initial treatment for RA

A

NICE recommend DMARD monotherapy +/- a short-course of bridging prednisolone

23
Q

Options for DMARD therapy

A

Methotrexate
sulfasalazine
leflunomide
hydroxychloroquine

23
Q

Why must patients have FBC and LFTs monitored on Methotrexate?

A

due to the risk of myelosuppression and liver cirrhosis.

24
Q

How do we monitor response to DMARD treatment?

A

combination of CRP and disease activity score (DAS28 score)

25
Q

management of RA flare

A

corticosteroids - oral or intramuscular

26
Q

Indication for TNF inhibitor therapies

A

inadequate response to at least two DMARDs including methotrexate

27
Q

options of TNF inhibitor therapies

A

etanercept
infliximab
adalimumab

28
Q

Which anti-CD20 monoclonal antibody infusion can be used to treat RA?

A

Rituximab (B-cell depletion)
2x 1g intravenous infusions are given two weeks apart

29
Q

What is Abatacept?

A

fusion protein that modulates a key signal required for activation of T lymphocytes

leads to decreased T-cell proliferation and cytokine production

(NOT YET APPROVED BY NICE)

30
Q

RA symptoms tend to improve in pregnancy and flare following delivery. TRUE/FALSE?

A

TRUE
- patients with early or poorly controlled RA should be advised to defer conception until their disease is more stable

31
Q

What DMARDs are safe in pregnancy?

A

SAFE: = sulfasalazine and hydroxychloroquine

UNSAFE = Methotrexate and leflunomide

low-dose corticosteroids may be used in pregnancy to control symptoms

32
Q

Clinical features

A

swollen, painful joints in hands and feet
stiffness worse in the morning
gradually gets worse with larger joints becoming involved
insidiously onset
positive ‘squeeze test’

33
Q

Describe the names given to RA bony deformities in the hands

A

Swan neck and boutonnière deformities

34
Q

Poor prognostic features

A

rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (< 2 years)
extra articular features
HLA DR4
insidious onset

35
Q

Early XR findings in RA

A

loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation

36
Q
A

MRCP Rheumatology (70 decks)

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