Rheumatoid Arthritis Flashcards
What type of condition is rheumatoid arthritis?
Chronic, autoimmune condition
What is characteristic of rheumatoid arthritis?
Symmetrical polyarthritis and systemic symptoms
What is meant by rheumatoid arthritis being polyarthritis?
At least four joints are involved
Which joints tend to be affected by rheumatoid arthritis?
Small joints, commonly MCJ, PIPJ
How long do symptoms need to be present for a diagnosis of rheumatoid arthritis to be made?
Six weeks
Who is more likely to get rheumatoid arthritis?
Females > males
Peak incidence is in 4th and 5th decade but can occur from age of 16
What are the causes of rheumatoid arthritis?
Genetic- 50%
Environmental
Hormonal
Which gene is associated with rheumatoid arthritis?
HLA-DRB1
B is beta idk how to get that sign…writing these on my tablet, you feel the pain
What are some of the environmental factors which can cause rheumatoid arthritis?
Smoking
Chronic infection e.g. EBV, periodontal disease
Which hormonal changes can cause rheumatoid arthritis?
Early menopause
Low testosterone levels in men
Symptoms of rheumatoid arthritis?
Pain
Morning stiffness >30mins
Immobility
Poor function
Systemic symptoms
->apparently some patients with rheumatoid arthritis have to get up several hours before work so the stiffness wears off so they can get ready
Signs of rheumatoid arthritis?
Tenderness
Redness
Warmth
Swelling
Limited movement
There are a few joints that rheumatoid arthritis cannot affect. If a patient presents with issues and pain with these joints, rheumatoid arthritis can be ruled out.
What are some of these joints?
Spinous joints e.g. lumbar joints- if affected by arthritis, it tends to be inflammatory rather than rheumatoid
Sacroiliac joints
Sometimes hand with established rheumatoid arthritis can develop ulnar deviation, what does this mean?
Fingers and joints start pointing medially, towards ulna
What are some of the non-specific systemic features of rheumatoid arthritis?
Fatigue
Weight loss
Anaemia
What are some of the specific organs affected systemically due to rheumatoid arthritis?
Eyes
Lungs
Nerves
Skin
Kidneys
What are the baseline investigations used for diagnosis of rheumatoid arthritis?
Bloods
Immunology
In the long term, what systemic issues can be as a result of rheumatoid arthritis?
CVS problems
Malignancy
Which bloods are done in suspicion of rheumatoid artheritis?
FBC
LFTs
Kidney function tests
CRP
ESR
What is looked at in immunology if rheumatoid arthritis is suspected?
Anti-Cyclic Citrullinated Antibodies (anti-CCP)
Rheumatoid factor but that is present in differing levels for other conditions so not specific
Which score can be used in the assessment of rheumatoid artheritis?
Disease Activity Score (DAS)
In rheumatoid arthritis, what does a DAS score of <2.6 mean?
Clinical remission
In rheumatoid arthritis, what does a DAS score of >5.1 mean?
Patient eligible for biologic therapy
What are some of the other investigations used in rheumatoid artheritis?
Xrays
Ultrasounds - show synovial hypertrophy
Key part of treatment is early aggressive treatment to allow for optimal outcomes.
What are the different area of management for rheumatoid arthritis?
Pharmacological treatment
Multidisciplinary care
Management of flares
Surgery
If a patient presents for the first time with rheumatoid arthritis or has a flare up, what can be given?
NSAIDs e.g. ibuprofen or naproxen
Glucocorticoids (steroids) e.h. prednisone
What forms part of disease modifying management for rheumatoid arthritis?
Biologic DMARDs e.g. TNF-a
Conventional synthetic DMARDs e.g. methotrexate
Targeted synthetic DMARDs
Who forms a part of the MDT for rheumatoid arthritis?
Rheumatologist
Specialist nurse
Physiotherapist
Occupational therapist
Podiatrist
Pharmacist
Psychologist
