Rheumatoid arthritis Flashcards

Question

What is ulnar deviation?

Answer 1

Due to inflamed MCP joints, causes fingers to be dislocated As tendons pull on dislocated joints, fingers drift towards ulnal side

Answer 2

Inflammation can lead to general weakness, drousiness and exhaustion Pain can impact quality of sleep Can take while to get comfortable to sleep More likely to get fatigued Medication and inactivity can lead to more tiredness

Answer 3

The fatty pad which protects the sole of the foot detriorates and gets pushed to the side Causes pain and increased pressure, reduced shock absorption

Answer 4

This refers to loss of bone mineral bone density BMD that weakens bones Indication of past inflammation around joint - one of earliest signs of RA

Answer 5

Inflammation of the synovium of a joint Immune system attacks the joint - type II collagen in articular cartilage > progresses to proliferating synovial tissue extends to articular cartilage and erodes from the joint surface down to subchondral bone

Answer 6

Inflammation of the fluid filled synovium within the tendon sheath Typically in hands, feet and arm Greatly reduces movement

Answer 7

Eyes: dry eyes, episcleritis, scleritis, scleromalacia Skin: ulcers NS: carpal tunnel syndrome, peripheral neuropathy, cervical myelopathy, vasculitis Blood vessels: premature atherosclerosis, vasculitis Lungs: pulmonary fibrosis, pulmonary nodules, pleurisy Heart: pericarditis, pericardial effusion Blood: anaemia, thrombocytosis

Answer 8

Inflammatory condition of collagen Sclera and cornea primarily made from collagen Episcleritis - red eye with pain Scleritis - red eye without pain

Answer 9

Inflammation of the pleural layers - thickening of pleural tissue, and fluid collects in pleural space Can be diretly from RA, or treatments - immune system suppressed - chest infections

Answer 10

Uncontrolled inflammatory conditions Chronic inflammation may impact ability to use stored iron to produce new RBCs Can affect production of erythropoietin - decreased levels of RBCs

Answer 11

Prevalence - 1% of the population, most common type of inflammatory arthritis Incidence is low 3.6 women per 100.000 Peaks between 30-50 yrs Peak age is 70 yrs 2-4x more common in women

Answer 12

Genetics: family history Gender: women more likely Age: risk increases with age - most common between 30-60 Hormones: changes in hormone levels Environmental factors: smoking, alcohol Obesity Occupational exposure: exposure to dust, asbestos

Answer 13

Osteoarthritis: typically asymmetrical, morning stiffness for 30 mins or less, improves with movement. Gradual onset Symptoms localised to joint. Commonly seen in weight bearing joints Gout: accumulation of urate crystals in joints > inflammation. Sudden onset Systemic lupus erythematosus SLE: systemic autoimmune disease, antinuclear antibodies

Answer 14

GALS examination Joint inspection Medical history Blood tests - ESR, RF, anti-CPP X-ray Ultrasound

Answer 15

Gait, arms, legs and spine Tests for: pain in TMK and MCP and MTP joints diminished grip strength impaired fist formation inability to extend elbows fully If abnormality detected, area should be further investigated

Answer 16

Further inspection of look feel move Swelling, tenderness and warmth Positive MCP squeeze test Symmetrically affected

Answer 17

Family history of RA Early morning stiffness more than an hour Clinical judgement of persistent synovitis Look for extra-articular features, involvement of other systems Refer within 3 days if suspected

Answer 18

Rate at which RBCs in anticoagulated whole blood takes to descend in a standardised tube over an hour If high, means they fall faster - will have more protein in them - sign of inflammation Not specific to RA

Answer 19

Rheumatoid factors are autoantibodies against the Fc portion of IgG (antibody) RF can belong to any isotype of immunoglobulin Any of these can be detected ELISA can differentiate between different subtypes of RF Presence of RF does not mean RA Most common in RA is rheumatoid factor IgM

Answer 20

Over 14 IU/ml Higher the level the worse the joint destruction and greater chance of systemic involvement

Answer 21

Anti-citrullinated protein antibodies These autoantibodies produced by B cell in the joint If found, may show PADI enzyme is present - catalyse deamination of arginine amino acid to citrulline > citrullination of synovial proteins e.g. fibrin, keratin, type II collagen More specific and sensitive than RF for RA, but not all RA patients have anti CPP

Answer 22

Above 20 u/ml Small minority of patients do not have autoantibody

Answer 23

JOINTS - Joint erosion - Bone space narrowing - Osteopenia - increased radiolucency - darker - Soft tissue swelling - earliest sign - Eventual bone displacement - Bilateral and symmetrical involvement - Distal IP joints spared LUNGS - Pulmonary nodules

Answer 24

Hyperplasia thickened synovium Enlarged joint space Doppler signal neurovascularisation in inflammation Synovitis Erosions Tenosynovitis

Answer 25

Keeping healthy weight - overweight puts pressure on joints Diets - Mediterranean diets reduces symptoms related to chronic inflammation. Probiotics may lead to reduced inflammatory markers Turmeric - immunomodulatory and anti-inflammatory ingredients that moderately effective in RA Cod liver oil - source of omega 3 fatty acids which have anti-inflammatory effects Reflexology - massage of hands and feet and ears in specific points to target different body regions

Answer 26

Methotrexate works by interfering with folate metabolism - side effects: mouth sores, nausea, fatigue Folic acid helps offset side effects

Answer 27

Trimethoprim works by inhibiting bacterial dihydrofolate reductase, but also has an effect on the human dihydrofolate reductase Trimethoprim breaks down methotrexate, causing it to build up in harmful levels - usually eliminated through kidneys, trimethoprim slows this down Liver toxicity, bone marrow suppressions, other complications

Answer 28

Antimalarial DMARD

Answer 29

Affects function of lysosomes by increasing pH of lysosomes Accumulation in organelles Inhibits antigen processing, prevents alpha and beta chains of MHC class II dimerising > Inhibits antigen presentation > Reduces inflammatory response - high PH reduces MHC recycling - only high affinity complexes are presented > Self peptides with low affinity won't bind = reduced autoimmunity Reduces cytokine release possibly by TLR inhibition Increased pH makes ACE2 receptors which interact with spike proteins of SARS-CoV, less efficient

Answer 30

Uncomplicated malaria and chemoprophylaxis - preventing disease/infection Lupus erythematosus Acute an chronic RA

Answer 31

Metabolised by intestinal bacteria broken down into mesalazine and sulfapyridine Targets COX and LOX enzymes, so inhibits leukotrienes and prostaglandins Inhibits phospholipase A2 (LOX pathway) and COX 1 and 2 enzymes COX2 inhibition reduces inflammation, apoptosis by reducing production of PGEs Also inhibits folate metabolising enzymes - used for DNA synthesis

Answer 32

Inhibits folate metabolism > prevents DNA synthesis > reduced ability to produce inflammatory cells, but not thought to be the main mechanism Adenosine signalling: MTX inhibits AICAR which blocks adenosine deaminase > build up of adenosine Adenosine medaites anti-inflammatory effects by stimulating A2a and A3 receptors Promotes macrophages to transform to M2 phenotype - release less TNF-a and IL-2 (proinflammtory mediators) than M1, and increase IL-10, IL-13 and VEGF to promote fibrosis and angiogenesis for resolution of inflammation

Answer 33

Designed to diagnose and treat arthritis in early stages GP referral > 6 weeks Diagnosis from blood tests and x-rays, prescribed DMARDs > Referral to early inflammatory arthritis clinic, nurse led - ask about medications and symptoms > 2 months MDT early arthritis clinic with review meetings

Answer 34

Charity that supports patients - Support services - Research funding - Advocacy and awareness - Education - Campaigns

Answer 35

National audits: collect and analyse data supplied by local clinicians to provide picture of care standards for the specific condition

Answer 36

- Clarifying with the patient what the medication is for - State how and when to take them - State how long the medication takes to work - State the potential side effects of the medication - Provide lifestyle advice and suggest support groups - Offer written information to take home

Answer 37

Disease activity score Measure of disease in RA 28 refers to 28 joints that are examined in the assessment Mathematical formula takes into account: No of tender and swollen joints Blood test to measure inflammation via ESR Personal assessment of overall disease activity Score greater than 5.1 suggests high disease activity Score less than 2.6 suggests disease remission

Answer 38

Hands, wrists, elbows, shoulders, knees