Rheumatoid Arthritis

Question 1

What is rheumatoid arthritis?

Answer 1

An autoimmune condition which causes chronic inflammation of the synovial lining of the joints

Question 2

Who is rheumatoid arthritis more common in?

Answer 2

3 times more common in women than in men

Question 3

What are the gene associations with rheumatoid arthritis?

Answer 3

HLA DR4
HLA DR1

Question 4

What antibodies may be present in a patient with rheumatoid arthritis?

Answer 4

Rheumatoid factor
Anti-CCP antibodies

Question 5

What are the key symptoms in rheumatoid arthritis?

Answer 5

Joint pain
Joint swelling
Morning stiffness < 30 minutes
Pain that gets better with exercise
Fatigue
Weight loss
Flu like illness

Question 6

Which joints are commonly affected in rheumatoid arthritis?

Answer 6

Proximal interphalangeal joints (PIP)
Metacarpophalangeal joints (MCP)
Wrists
Ankles
Cervical spine

Question 7

What hand signs may be present in someone with rheumatoid arthritis?

Answer 7

Z thumb
Swan neck deformity
Boutonnieres deformity
Ulnar deviation

Question 8

What are the extra-articular manifestations of rheumatoid arthritis?

Answer 8

Pulmonary fibrosis
Bronchiolitis obliterans
Sjogren’s syndrome
Anaemia of chronic disease
Cardiovascular disease
Episcleritis and scleritis
Rheumatoid nodules

Question 9

What investigations may be carried out in the diagnosis of rheumatoid arthritis?

Answer 9

Rheumatoid factor
Anti-CCP antibodies
CRP and ESR
XR hands and feet
Ultrasound to confirm synovitis

Question 10

What changes may be seen on XR in someon with rheumatoid arthritis?

Answer 10

Joint destruction and deformity
Soft tissue swelling
Periarticular osteopenia
Bony erosions

Question 11

What factors are indicative of a worse prognosis?

Answer 11

Younger onset
Male
More joints and organs affected
Presence of RF and anti-CCP antibodies
Erosions seen on XR

Question 12

What is the first line management of rheumatoid arthritis?

Answer 12

Monotherapy with methotrexate, leflunomide or sulfasalazine

Question 13

What is the second line management of rheumatoid arthritis?

Answer 13

Dual therapy with methotrexate, leflunomide or sulfasalazine

Question 14

What is the third line management of rheumatoid arthritis?

Answer 14

Methotrexate plus a biological therapy (usually a TNF inhibitor)

Question 15

What is the fourth line management of rheumatoid arthritis?

Answer 15

Methotrexate plus rituximab

Question 16

What anti-TNF medications are commonly used in the treatment of rheumatoid arthritis?

Answer 16

Infliximab
Adalimumab
Etanercept

Question 17

What is the treatment of an initial presentation or a flare up of rheumatoid arthritis?

Answer 17

A short course of glucocorticoids - prednisolone

Question 18

How is methotrexate taken for rheumatoid arthritis?

Answer 18

Methotrexate is taken orally or intramuscularly
Folic acid 5mg is given once a week, on a different day to the methotrexate

Question 19

What are the side effects of methotrexate?

Answer 19

Mouth ulcers
Liver toxicity
Leukopenia
Teratogenic

Question 20

What are the differentials of rheumatoid arthritis?

Answer 20

Osteoarthritis
SLE
Fibromyalgia
Septic arthritis
Psoriatic arthritis
Polyarticular gout
Reactive arthritis

Question 21

Which medications are safe for rheumatoid arthritis patients during pregnancy?

Answer 21

Sulfasalazine and hydroxychloroquine