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2a MSK and Rheumatology > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

RA is a inflammatory autoimmune p______

A

polyarthritis

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2
Q

Does RA normally present symmetrically or asymmetrically?

A

Symmetrically

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3
Q

What are risk factors for RA?

A

Women
Aged 30-50
Smoking

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4
Q

What genes are associated with RA?

A

HLA DR4
HLA DRB1

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5
Q

In genetically susceptible individuals, an _______ trigger may activate the immune system, leading to an autoimmune response

A

environmental

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6
Q

RA is due to a mutation in type _ collagen

A

2

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7
Q

In RA there is increased conversion of a____ to c___ (amino acids) in type 2 collagen to make citrullinated peptides

A

arginine to citruline

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8
Q

The immune system recognises citrullinated proteins as foreign and triggers the production of antibodies including a___-___

A

anti-CCP
anti- cyclic citrullinated peptide

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9
Q

The immune complexes containing anti-CCP and citrullinated peptides contribute to c_____ i______ and damage within the synovium

A

chronic inflammation

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10
Q

Persistent inflammation contributes to j____ d____, e______, and characteristic d_____

A

joint damage, erosion, deformities

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11
Q

What contributes to further pro-inflammatory recruitment to synovium?

A

IFN-a

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12
Q

The synovial lining expands and tumour like mass called _____ grows past the joint margins

A

pannus

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13
Q

The pannus destroys s_______ bone and articular c____

A

subchondral bone
articular cartilage

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14
Q

What time of day are symptoms worst?

A

In morning, at least first half hour.

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15
Q

name some deformities that could be seen in the hand?

A

Boutonniere
Swan neck
Z-thumb
Ulnar deviation

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16
Q

What is a popliteal synovial sac bulge called?

A

Baker’s cyst

17
Q

What joints in the hand are often affected in rheumatoid arthritis?

A

MCP
PIP
(not DIP)

18
Q

True or false: the joints are not normally hot or inflamed in RA

A

False

19
Q

What joints are commonly affected in RA?

A

Wrist
Hand
Feet

Can affect ankles, knee, hips, shoulder and cervical spine

20
Q

What are some extra-articular complications of RA?

A

PE in lungs
Pulmonary fibrosis
Increased risk of ischaemic heart disease
Episcleritis
Dry eyes
Spinal cord compression
CKD
Rheumatoid skin nodules

Due to chronic systemic inflammation and elevated inflammatory mediators circulating

21
Q

What is a rare complication of long-standing RA?

A

Felty syndrome

22
Q

What is the characteristic triad of Felty syndrome?

A

Rheumatoid arthritis
Neutropenia (low neutrophils)
Splenomegaly

23
Q

What does Felty Syndrome mean?

A

Increased risk of infection that could be life-threatening

24
Q

How do you diagnose RA?

A

Bloods:
Increased ESR and CRP
Normocytic normochromic anaemia
(can cause micro/macrocytic anaemia from medications)

Serology:
Positive anti-CCP
Positive RF (rheumatoid factor)

X-ray

25
Q

What does RF do?

A

Rheumatoid Factor causes immune system activation against the patient’s own Fc portion of IgG resulting in systemic inflammation

26
Q

What are the changes on an X-ray seen due to RA?

A

LESS

Loss of joint space
Eroded bone
Soft tissue swelling
Soft bones (osteopenia)

27
Q

What are the X-ray changes in osteoarthritis?

A

LOSS

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

28
Q

What is used to monitor disease progression in RA?

A

ESR and CRP

29
Q

How do you treat RA?

A

DMARD - methotrexate (gold standard)

NSAID for analgesia

If very painful: intraarticular steroid injection

Biologics (good but expensive)
First line = Infliximab with methotrexate
Second line = rituximab

30
Q

What is prescribed alongside methotrexate?

A

Folic acid

31
Q

When is methotrexate contraindicated?

A

Pregnant ladies due to being a folate inhibitor

32
Q

What exactly does infliximab do?

A

TNF-a inhibitor

33
Q

How does rituximab work?

A

B cell inhibitor (CD20 target)

Monoclonal antibody, targets CD20 proteins on surface of B cells.

Immunosuppression

34
Q

What is used instead of methotrexate in pregnant ladies with RA?

A

Sulfasalazine
Hydroxychloroquine
NSAIDs
Corticosteroids

35
Q

How often is methotrexate taken?

A

1 tablet once a week

Folic acid also taken, one tablet once a week on different day to methotrexate

36
Q

Hydroxychloroquine is traditionally an a__-______ medication

A

anti-malarial

37
Q

How does hydroxychloroquine suppress the immune system?

A

Interferes with toll-like receptors, disrupting antigen presentation.
Increases pH in lysosome of immune cells

2a MSK and Rheumatology (31 decks)

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