Rheumatoid Arthritis

Question 1

definition of rheumatoid arthritis

Answer 1

chronic autoimmune disease that is characterized by inflammatory arthritis and multisystem involvement

Question 2

who gets dx with RA

Answer 2

typically dx in young females ages 20-40

Question 3

RF for RA

Answer 3

• smoking
• female
• genetics (HLA) /fhx of autoimmune conditions
• exposure: silica
• obesity

Question 4

patho for RA

Answer 4

1. genetic suseptibility + environmental trigger
2. antigen that is able to trigger an immune response (this could be citrullinated proteins)
3. initiated an inflammatory response
4. within the joint there is cytokine release (TNF-alpha and IL-6) that result in the formation of a pannus from the synovial membrane ➔ hyperplasia and results in boggy joint and inflammed and swollen and red
5. there may also be some level of bone breakdown from the inflammation
6. elsewhere in the body, there can be deposits of immune complexes (T3 hypersensitiivty rxn) that result in extraarticular s/s (RF is created in response to inappropriate IgG)

Question 5

what are cardinal signs for RA

Answer 5

• morning stiffness >1h
• pain gets better with movement
• MC involves MCP and PIP ➔ spares the DIP
• symmetric
• rheumatoid nodules
• boutonniere’s sign
• swan neck sign
• lung nodules/fibrosis
• Raynaud phenomenon

Question 6

how to dx RA

Answer 6

RF
anti-CCP
C3 and C4 - would be normal in RA
ESR/CRP
CBC ➔ anemia of chronic disease

could consider imaging but would more so see the consequences of the chronicity of the RA

Question 7

how to tx RA

Answer 7

firstline: non-biologic DMARD (methotrexate) + folic acid supplementation
second-line: biologic DMARD (TNF-alpha inhibitor or IL-6 inhibitor)

symptom management: NSAIDs, steroids (PO or injection during flares)