Rheumatoid arthritis

Question 1

What is rheumatoid arthritis

Answer 1

Chronic symmetrical inflammatory autoimmune disease that affects synovial joints characterised by swelling, joint pain & synovial destruction

Question 2

Aetiology of rheumatoid arthritis

Answer 2

Genetics
Hormones (3:1 female to male ratio)
Environment (infection & smoking)

Question 3

Pathophysiology of rheumatoid arthritis

Answer 3

Non-specific inflammation affects the synovial tissue and is amplified by T-cell activation

Question 4

Auto-antibodies involved in rheumatoid arthritis

Answer 4

Rheumatoid factor
Anti-CCP antibodies

Question 5

What is rheumatoid factor SS

Answer 5

Sensitivity = 50-80%
Specificity = 70-80%
- High titres are more at risk of extra-articular disease

Question 6

What is Anti-CCP antibodies SS

Answer 6

Sensitivity = 60-70% (absence does not exclude disease as too low)
Specificity = 90- 99%
- present many years before articular symptoms (relevant to smoking current and history)

Question 7

Clinical Presentations of rheumatoid arthritis

Answer 7

Symmetrical pain & joint swelling
Common in small joints hand & feet
Prolonged early morning stiffness
Pain improves with activity
Joint deformities
Atlanto-axial subluxation

Question 8

What are the common 2 joint deformities seen in RA

Answer 8

Swan neck deformity = PIP hyperextension and DIP flexion

-Boutonniere deformity = PIP flexion and DIP hyperextension

Question 9

What is Atlanto-axial subluxation as it occurs in RA

Answer 9

Misalignment of the 1st & 2nd cervical vertebrae causing excessive joint movement

Question 10

Clinical Signs of RA

Answer 10

Swelling of affected joints
Bouchard’s nodes = on PIP joints
Positive compression tests of MCP and MTP joints
Synovial herniation - cysts e.g. Baker’s cyst

Question 11

Common extra-articular manifestations

Answer 11

Sjogren syndrome
Raynaud’s
Malaise, weight loss, fever
Pericarditis, myocarditis
Osteoporosis

Question 12

Imaging used in RA

Answer 12

X-ray (late disease see erosions & subluxation)
Subluxation is dislocation incomplete or partial
MRI to see disease progression

Question 13

What would be seen in bloods of RA patient

Answer 13

high CRP, PV and ESR
RF factor or anti-CCP antibodies

Question 14

Management RA 1st line

Answer 14

DMARDS e.g. methotrexate, sulfasalazine
(disease-modifying anti-rheumatic drugs)
aim is to start within 3 months of symptom onset

Question 15

Management RA 2nd line

Answer 15

Biologics
Only given if 2 DMARDs have been tried and fail
e.g. Anti-TNF agents

Question 16

What other members of MDT useful in RA treatment

Answer 16

Physiotherapists
Occupational therapists
Podiatrists

Question 17

What is the major complication of Atlanto-axial subluxation

Answer 17

Cervical cord compression (nerves root impinged)