Rheumatoid Arthritis - 224

Question 1

In RA where is the primary site of pathology?

Answer 1

Synovium

Question 2

Give some examples of extra-articular manifestations in RA

Answer 2

Nodules and rash

Question 3

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

Answer 3

Neutrophils

Question 4

Describe the joint pathology in RA

Answer 4

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

Question 5

What are the genetic associations with RA?

Answer 5

HLA-DR4

PTPN22

Question 6

Give 4 articular features of RA

Answer 6

• Reduced movement
• Joint effusion
• Synovitis
• Deformity

Question 7

Describe what is happening in a swan-neck deformity

Answer 7

PIP hyperextension and DIP in fixed flexion (bent)

Question 8

What acute-phase reactants are raised in RA?

Answer 8

ESR and CRP

Question 9

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

Answer 9

Rheumatoid factor and anti-CCP

Question 10

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

Answer 10

Nail fold infarcts, leg ulcers, distal sensory neuropathy

Question 11

What are some ocular associations with severe RA?

Answer 11

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

Question 12

Give an example of a neurological association with RA

Answer 12

Carpal tunnel

Atlanto-axial subluxation

Question 13

What signs are present in Felty’s syndrome?

Answer 13

RA, splenomegaly, leucopaenia

Question 14

What DMARDS can you use to treat RA?

Answer 14

Methotrexate -> given with folic acid
Sulphasalazine
Lefluonamide

Question 15

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

Answer 15

Infliximab

Adulimumab

Question 16

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

Answer 16

Biological. Anti CD-20

Question 17

How does Tocilizumab work? When might it be used?

Answer 17

Anti-IL-6

Used for RA after an anti-TNF

Question 18

What cyotkines are proinflammatory in RA?

Answer 18

TNFalpha, IL-1

Question 19

What cytokines are anti-inflammatory in RA?

Answer 19

IL-10

Question 20

Giant cell arteritis is commonly accompanied by what?

Answer 20

Polymyalgia rheumatica (PMR)

Question 21

What type of vasculitis if GCA?

Answer 21

Large vessel - limited to vessels with an elastic component

Question 22

How do you treat GCA and PMR?

Answer 22

Prednisolone

Question 23

Give some symptoms of GCA

Answer 23

Headache, jaw claudication, fatigue, visual problems

Question 24

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

Answer 24

ENT - nose.

Question 25

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

Answer 25

c-ANCA. | Destructive vasculitis, small vessel

Question 26

What is the pathology in polyarteritis nodosa?

Answer 26

Aneurysm formation in medium sized vessels.

Question 27

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

Answer 27

Adult onset asthma

Question 28

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

Answer 28

Connective tissue diseases

Question 29

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

Answer 29

Women, 9:1 | Most common in black and Chinese people

Question 30

Give some symptoms and signs of SLE

Answer 30

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

Question 31

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

Answer 31

ANA/ANF | dsDNA antibodies

Question 32

How do you treat SLE?

Answer 32

For joint/skin manifestations use: Hydroxychloroquine | If systemic disease use Prednisolone

Question 33

What are some haematological features seen in SLE?

Answer 33

Leucopenia, neutropenia, thrombocytopenia, lymphadenopathy, anaemia

Question 34

What syndrome is present in most people with scleroderma?

Answer 34

Raynauds

Question 35

Give some clinical features of Sjorgrens Syndrome

Answer 35

Dry eyes, dry mouth, salivary gland enlargement

Question 36

What auto-antibodies are often present in Sjorgrens Syndrome?

Answer 36

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

Question 37

Give an example of a supportive treatment for Sjorgrens Syndrome

Answer 37

Artificial tears and saliva

Question 38

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

Answer 38

Sjorgrens Syndrome