rheumatoid arthritis Flashcards
what is rheumatoid arthritis?
- chronic autoimmune disease
what does rheumatoid arthritis mostly affect?
- mostly affects joints
when does rheumatoid arthritis occur?
- occurs when the immune system attacks its own tissues
what is the normal role of the immune system?
- normally helps protect the body from infection
what does rheumatoid arthritis cause? (4)
- pain
- swelling
- stiffness
- loss of function in joints
what is similar to OA?
- rheumatoid arthritis symptoms
how does rheumatoid arthritis differ from osteoarthritis?
- different cause, lifespan and it is a systemic illness
what is it called when more than 5 joints are affected at one time?
- polyarthropathy
how is rheumatoid arthritis highly characterised?
- highly characterised by flare- ups/ remissions
what are flare ups?
- where most tissue damage occurs
- very painful and debilitating
what does rheumatoid arthritis disease process begin with?
- begins with activation of immune cells e.g., T and B lymphocytes
what do T and B cells infiltrate? what does this cause?
- infiltrate the synovium
- initiates a cascade of inflammatory cytokine release
what does the cytokine release include? (3)
- TNFa
- IL1
- IL6
what does the inflammatory setting promote? what does this lead to?
- inflammatory setting promotes synovial hyperplasia and angiogenesis
- leading to pannus formation, cartilage destruction and bone erosion
what cells manufacture rheumatoid factors?
- plasma cells
what do plasma cells manufacture? - give an example
- manufacture antibodies
e.g., against type II collagen
what does activation of periosteal osteoclasts lead to?
- leads to periarticular bone erosion
what is damage to articular surfaces mediated by? - give an example
- mediated by matrix degrading enzymes e.g., matrix metalloproteinases
what is the disease described as?
- heterogenous
what is the hallmark of the advanced disease of RA?
- persistent inflammation of the synovium
- which usually involves peripheral joints in a symmetrical distribution
how does polyarthritis present?
- symmetrical
what is polyarthritis described as?
- destructive
what six areas does polyarthritis usually occur?
- hands (MCPs and PIPs)
- wrists
- feet (MTPs and PIPs)
- knees
- shoulders
- elbows
what level of the spine does polyarthritis usually occur?
- C1 to C2 (atlantoaxial)
is rheumatoid arthritis more common in males or females?
- female : male ratio is 3:1
when does the onset of RA occur?
- occurs at any age
when is the peak of rheumatoid arthritis?
- aged 30-50 years
how much of the UK population is affected by RA?
- 1%
how many people stop working within 2 years of RA onset?
- 1/3 stop work within 2 years
how many people living worldwide have RA?
- 18 million people worldwide are living with rheumatoid arthritis
what is the increased mortality rates for people with RA?
- 1.5 to 1.6 increased mortality rates
what are oral health risk factors of RA?
- chronic periodontitis
- tooth loss
what are the sex- specific risk factors?
- post menopause
- anti oestrogen treatment
what are lifestyle risk factors for RA?
- obesity
- stress
what are respiratory risk factors of RA?
- inhaled pollution
- smoking
- COPD
- asthma
what are genetic risk factors of RA?
- family history
- ethnicity
what are intestinal risk factors of RA?
- chronic diarrhoea
- sugar- sweetened beverages
what area is most commonly affected? how many cases?
- most commonly affects hands
- 90% of cases
what does rheumatoid arthritis primarily affect?
- primarily affects the synovium (synovitis)
what is ulnar rift?
- inflammation leads to your fingers bending towards your pinkie
what is swan neck?
- DIP flexion with PIP hyperextension
what other area of the body does RA commonly affect? what percentage of cases?
- feet
- 60% of cases
- MTP and PIPs
what are bunions?
- form on the joint where your big toe meets your foot
what are hammertoes?
- unusual bend in the middle joint of a toe
are joints only affected in rheumatoid arthritis?
- not just joints affected
- 25% of cases are rheumatoid nodules
what percentage of cases have erosions within 1 year of RA onset?
- up to 60% have erosions within 1 year of RA onset
what are the 3 cases of bone erosion?
- focal bone loss : subchondral and joint margins
- local (periarticular) osteopenia
- generalised osteoporosis
what is Sjogren’s syndrome?
- glands that produce fluid stop working properly
what does sjogren’s syndrome affect? (2)
- exocrine glands, particularly salivary and lacrimal glands
how many rheumatoid arthritis cases have sjogren’s syndrome?
- 30% of RA cases
what risk does RA increase?
- risk of heart attacks increases 60% one year after diagnosis
what test is completed for clinical history of RA? what is this especially used for?
- blood test
- especially small joint
what do RA patients have an increase in their bloods? (2)
- increased ESR
- increased CRP
what is it called when your rheumatoid factor test is positive>
- seropositive
what is the antibody found in blood tests of rheumatoid arthritis? what percentage specificity?
- anti cyclic citrullinated peptide (anti- CPP) antibodies
- 95-98% specificity
what three treatments for rheumatoid arthritis is the same for osteoarthritis?
- conservative
- education and self management
- surgery
what are the other treatments used for RA that are different to osteoarthritis?
- pharmacology
- splining
- joint protection
- adaptive devices
what is the pharmacological treatment DMARDS?
- disease modifying anti- rheumatic drugs
what are the 4 medicines that immunosuppress RA?
- methotrexate
- leflunomide
- hydroxychloroquine
- sulfasalazine
what are the steroids methods used in pharmacology treatment? (5)
- tablets
- injections
- inhalers
- nasal sprays
- lotions
what biological treatment can be taken in conjunction with DMARDs?
- Adalimumab
what are the newest class of medicine used to treat rheumatoid arthritis?
- JAK inhibitors
what are the mainstay of pain medications?
- non steroidal anti- inflammatory drugs
what do splints/ orthoses reduce and prevent?
- decreases pain
- reduces swelling
- prevent deformity
what are examples of orthoses? (5)
- resting hand splints
- wrist supports
- finger splints
- special shoes
- shoe inserts
what do hand/ wrist splints help increase?
- increase ADLs when RA is very painful by providing support
what footwear helps with foot pain?
- padded footwear with Velcro straps
what can be useful with foot pain?
- heavy duty insoles
- gel toes separators
what are telescopic shoehorns?
- device that helps individuals take off your shoes without requiring you to reach down to floor level
what do podiatrists make? what do they deal with?
- can bespoke insoles
- deal with corns and calluses
what are the three principles for joint protection?
- use stronger joints when you can
- use less effort to do things
- use bigger grip
what do adaptive devices reduce?
- reduces effort
what is the Pt- DAS28 outcome measure?
- patient- derived disease activity score with 28 joint counts
what is the RADAI outcome measure?
- rheumatoid arthritis disease activity index
what is the RAPID outcome measure?
- routine assessment of patient index data
what are the quality of life questionnaires advocated for the systemic illness of RA? (3)
- health related quality of life questionnaire
- nottigham health profile
- SF 8/12/26
what other factors can blood tests test for?
- tests for side effects of the medication
