Rheumatoid arthritis Flashcards
symptoms
of inflammation
- Pain, swelling, early morning stiffness lasting longer than an hour ; as day goes on gets better
rapid onset
Cant make fists
who might get it
anyone
men and women both affected however 3;1 ratio of women
main structure involved
synovium
triggers
infections and smoking
what type of arthritis is it
chronic symmetrical poly arthritis; affects more than 5 joints
can it affect systems outwith joints
yes
triggers
infections and cigarette smooking
what does the severity depend on
genetic factors and presence of auto antibodies
what is raised in the blood
inflammatory markers, autoantibodies such as rheumatoid factor
what can be used for short term sympomatic relief
Analgesics, NSAIDs and steriods can be used short term for symptomatic relief
DMARDS
disease modifiying anti - rheumatic drugs
when do give dmards
within 3 months of symptom onset
what is first line drug
oral methotrexate
examples of DMARDS
Methotrexate
hydroxycholorquine
sulfasalazine
leflunomide
second line drugs
Biological disease modifying anti-rheumatic drugs (bDMARDs
examples of bdmards
anti-tnf agents and t cell receptor blockers
when to give bdmards
if have tried 2 DMARDs and patient still has DAS28 score > 5.1
DAS28
a measure of disease activity in rheumatoid arthritis (RA). DAS stands for ‘disease activity score’, and the number 28 refers to the 28 joints that are examined in this assessment
what additional med do patients with rheumatoid arthritis require
- Patients on DMARDs should receive theannual influenza vaccineand thepneumococcal vaccine every 5 yearsas per the schedule (neither vaccine is live)
- Patients aged over 50 years should receive thezoster vaccinationbefore starting bDMARDs or tsDMARDs
clinical features
polyarhralgia; pain in many joints
- Early morning stiffness > 30 mins that usually improves with activity
- Reduction in grip strength
- Joint deformities (‘rheumatoid hand’)
- Swan neck deformity: PIP hyperextension and DIP flexion
- Boutonniere deformity: PIP flexion and DIP hyperextension
- Atlanto-axial subluxation
extra articular manifestations
- Constitutional symptoms: low-grade fever, myalgia, malaise, fatigue, weight loss, night sweats
- Lungs: interstitial fibrosis, pneuomconiosis (Caplan syndrome), rheumatoid lung nodules, pleuritis, pleural effusions
- Fibrosis in RA has a predominance for the lower lobes
- Heart: pericarditis, myocarditis, increased risk of CVD
- Skin: pyoderma gangrenosum, Raynaud’s phenomenon, rheumatoid skin nodules
- Eye: keratoconjunctivitis
- Other MSK: osteopenia/osteoporosis, Sjogren syndrome
how might rheumatoid arthritis begin
Those with hla dr1 and dr4 may interact with smoke from cigarette/ pathogen causing modification of own anitgen such as IgG and type 2 collagen
hwo might type 2 collagen be modified
via citrullination when arginine is converted to citrulline
immune cells get confused and no longer recognise as self antigens
how does inflammation in the joint space occur
helper cells and antibodies enter circulation and reach joints where they recruit more cells
what happens once synovial cells are activated
activated via cytokines etc
create a pannus; thick synovial membrane made of aggressive macrophage- and fibroblast-like mesenchymal cells, macrophage-like cells and other inflammatory cells that release collagenolytic enzymes
what does chronic inflamamtion cause
angiogenesis; formation of new blood vessels around the joint causing more inflammation
what does the pannus produce
proteases whcih wear down the protein in cartilage
is methotrexate safe in pregnancy
no
