Rheumatoid arthritis Flashcards
What is rheumatoid arthritis (RA)?
A chronic, systemic autoimmune disease characterized by inflammation of the synovial joints, leading to joint destruction, pain, swelling, and reduced movement.
RA can also have extra-articular manifestations and significantly affect quality of life.
What factors contribute to rheumatoid arthritis?
Systemic inflammatory, genetic, and environmental factors.
What is synovitis in the context of RA?
Which two cytokines are commonly involved?
An immune-mediated attack on the synovium, resulting in inflammation and destruction of articular cartilage and bone.
Key immune cells and cytokines involved include TNF-alpha and IL-6.
What are the major risk factors for developing rheumatoid arthritis?
- Epidemiology: 2-4 times more common in women
- Family history
- Genetic predisposition: HLA-DR1 and HLA-DR4
- Age: Typically develops between 40-60 years
- Smoking
- Obesity
Remember HLA-DR1 and HLA-DR4 with the phrase: A RAce car needs 1 steering wheel and 4 wheels to DRive.
What are some constitutional symptoms of rheumatoid arthritis?
- Multiple, symmetrical joint pain, stiffness
- Fatigue
- Malaise
- Weight loss
- Myalgia
- Low-grade fever
What are some extra-articular complications of RA? Which common disease should be monitored and prevented?
- Reynaud’s phenomenon
- Skin rash
- Ocular conditions (e.g., keratoconjunctivitis sicca)
- Pulmonary involvement (e.g., pleural effusion)
- Anaemia of chronic disease
- Cardiovascular risks
- Neurological complications
- Felty’s syndrome (RA, neutropenia and splenomegaly
- Vasculitis
- Secondary Sjögren’s syndrome
- Cervical myelopathy
These complications can significantly affect patient health beyond joint issues.
What are common examination findings in RA?
- Rheumatoid nodules
- Deformities (in advanced cases)
- Swelling, tenderness, and warmth in affected joints
- Reduced range of motion
Rheumatoid nodules are firm, non-tender subcutaneous nodules over bony prominences.
What laboratory tests are used to diagnose rheumatoid arthritis?
- Rheumatoid factor (RF)
- Anti-cyclic citrullinated peptide (anti-CCP) antibodies
- Elevated ESR and CRP levels
RF is present in 60-70% of RA patients; anti-CCP is present in 80%.
What imaging findings are associated with rheumatoid arthritis?
- Soft tissue swelling
- Periarticular osteopenia
- Bone erosion/deformities
- Narrowed joint spaces
Advanced cases may show fused wrist bones.
What is the first-line pharmacological treatment for RA?
Disease-modifying antirheumatic drugs (DMARDs), primarily methotrexate.
Other DMARDs include sulfasalazine, leflunomide, and hydroxychloroquine.
What is the management approach for rheumatoid arthritis?
Consider the MDT
- Pharmacological treatment
- Physical therapy
- Occupational therapy
- Lifestyle modifications
Management may involve referrals to rheumatology for specialist assessment.
Fill in the blank: Methotrexate works by inhibiting _______ to reduce immune cell proliferation.
dihydrofolate reductase
This action helps slow disease progression and minimize joint damage.
True or False: Corticosteroids are used for flares in rheumatoid arthritis.
True
Corticosteroids, such as prednisolone, are often prescribed during flare-ups.
What are some side effects of Methotrexate?
It is typically administered weekly, with folic acid supplementation to reduce side effects.
- gastro-intestinal toxicity (stomatitis, diarrhoea),
- pulmonary toxicity,
- liver toxicity,
Methotrexate is contraindicated in active infection. Could usually restart 1 week after antibiotics are taken.
What scoring system is used to monitor activity of rheumatoid arthritis?
A Disease Activity Score (DAS) is a composite score that measures how active rheumatoid arthritis (RA) is in a patient.
DAS-28 for 28 joints.
