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Revision Notes - Year 2 > Rheumatoid Arthritis - 224 > Flashcards

Rheumatoid Arthritis - 224 Flashcards

1
Q

In RA where is the primary site of pathology?

A

Synovium

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2
Q

Give some examples of extra-articular manifestations in RA

A

Nodules and rash

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3
Q

In a patient with RA what is the major cell type in the synovial fluid?

A

Neutrophils

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4
Q

Describe the joint pathology in RA

A
  • Inflamed synovial membrane
  • Tcells, macrophages, fibroblasts, plasma cells, DCs and endothelium in pannus
  • Neutrophils in synovial fluid
  • Thinning of cartilage
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5
Q

What are the genetic associations with RA?

A

HLA-DR4

PTPN22

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6
Q

Give 4 articular features of RA

A
  • Reduced movement
  • Joint effusion
  • Synovitis
  • Deformity
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7
Q

Describe what is happening in a swan-neck deformity

A

PIP hyperextension and DIP in fixed flexion (bent)

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8
Q

What acute-phase reactants are raised in RA?

A

ESR and CRP

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9
Q

What factors might you look for in bloods of a patient with suspected RA?

A

Rheumatoid factor and anti-CCP

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10
Q

What might you see in a patient with small vessel vasculitis?

A

Nail fold infarcts, leg ulcers, distal sensory neuropathy

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11
Q

What are some ocular associations with severe RA?

A

Keratoconjunctivitis sicca (10-35%)
Episcleritis (red eye)
Retinal nodules
Scleromalacia

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12
Q

Give an example of a neurological association with RA

A

Carpal tunnel

Atlanto-axial subluxation

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13
Q

What signs are present in Felty’s syndrome?

A

RA, splenomegaly, leucopaenia

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14
Q

What DMARDS can you use to treat RA?

A

Methotrexate -> given with folic acid
Sulphasalazine
Lefluonamide

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15
Q

Name 2 anti-TNF agents you can use to treat RA

A

Infliximab

Adulimumab

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16
Q

What type of drug is Rituximab and how does it work?

A

Biological. Anti CD-20

17
Q

How does Tocilizumab work? When might it be used?

A

Anti-IL-6

Used for RA after an anti-TNF

18
Q

What cyotkines are proinflammatory in RA?

A

TNFalpha, IL-1

19
Q

What cytokines are anti-inflammatory in RA?

A

IL-10

20
Q

Giant cell arteritis is commonly accompanied by what?

A

Polymyalgia rheumatica (PMR)

21
Q

What type of vasculitis if GCA?

A

Large vessel - limited to vessels with an elastic component

22
Q

How do you treat GCA and PMR?

A

Prednisolone

23
Q

Give some symptoms of GCA

A

Headache, jaw claudication, fatigue, visual problems

24
Q

What is the most common presentation/affected area in Wegeners?

A

ENT - nose.

25
Q

What is Wegener’s and what ANCA is it associated with?

A

c-ANCA.

Destructive vasculitis, small vessel

26
Q

What is the pathology in polyarteritis nodosa?

A

Aneurysm formation in medium sized vessels.

27
Q

What is Churg-Strauss (small vessel vasculitis) linked with?

A

Adult onset asthma

28
Q

Systemic Lupus Erythematosus (SLE), Scleroderma, Inflammatory myopathies and Sjogrens syndrome are all what type of disease?

A

Connective tissue diseases

29
Q

Who is more commonly affected with SLE, men or women? By how much?

A

Women, 9:1

Most common in black and Chinese people

30
Q

Give some symptoms and signs of SLE

A

General: fever, weight loss, depression
Alopecia, rash (malar, discoid or photosensitive), mouth ulcers *Rash crosses nose!
Arthralgia, arthritis
Renal disease

31
Q

In 99% of patients with SLE what is found in serology?

A

ANA/ANF

dsDNA antibodies

32
Q

How do you treat SLE?

A

For joint/skin manifestations use: Hydroxychloroquine

If systemic disease use Prednisolone

33
Q

What are some haematological features seen in SLE?

A

Leucopenia, neutropenia, thrombocytopenia, lymphadenopathy, anaemia

34
Q

What syndrome is present in most people with scleroderma?

A

Raynauds

35
Q

Give some clinical features of Sjorgrens Syndrome

A

Dry eyes, dry mouth, salivary gland enlargement

36
Q

What auto-antibodies are often present in Sjorgrens Syndrome?

A

Rheumatoid factor, ANA, Anti-Ro, Anti-La

37
Q

Give an example of a supportive treatment for Sjorgrens Syndrome

A

Artificial tears and saliva

38
Q

What syndrome is associated with a 44x increased risk of lymphoma?

A

Sjorgrens Syndrome

Revision Notes - Year 2 (35 decks)

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