Rheumatoid arthritis

Question 1

Most common age of onset

Answer 1

40-60 years

Question 2

Risk factors for rheumatoid arthritis (3)

Answer 2

1. Family history (50% genetic component - MHC)
2. SMOKING!
3. Viruses (EBV, herpes)

Question 3

Signs and symptoms of rheumatoid arthritis (4)

Which joints are most commonly affected? (4)

Answer 3

1. Pain
2. Deformity (ulnar deviation, swan neck, boutonniere’s, Z-thumb, hammer toe)
3. Morning stiffness
4. Fatigue/low grade fever/malaise/LOA/LOW

Most commonly affected are the

1. Metacarpophalangeal joints
2. Proximal IP joints
3. Feet
4. Cervical spine

Question 4

Blood markers for rheumatoid arthritis (3)

Answer 4

1. Rheumatoid factor
2. Anti-CCP
3. Anti-MCV

Sensitivity and specificity for these tests are usually not high, but improved in combination.

Question 5

X-ray signs

Answer 5

LOSE

• Loss of joint space
• Osteopenia
• Subluxation
• Erosions

Question 6

Pharmacological management of rheumatoid arthritis

Answer 6

• NSAIDs
• Steroids
• DMARDs
  
  • Methotrexate
  • Sulfasalazine
  • Leflunomide
  • Infliximab - TNFa inhibitor
  • Anakinra - IL-1 blocker
  • Rituximab - monoclonal antibody against B cells
  • Abatacept - T cell blocker

Question 7

Extra-arthritic manifestations of rheumatoid arthritis (9) (CAN SCROLL)

Answer 7

• CVD (atherosclerosis, painless AMI, stroke, pericarditis, endocarditis, LVF, valvulitis, fibrosis)
• Anaemia
• Nodulear skin lesions
• Scleromalacia, dry eyes
• Carpal tunnel
• Renal amyloidosis
• Osteoporosis
• Lung disease (pleurisy, pleural effusion, pulmonary nodules, pulmonary fibrosis)
• Liver

15-25% patients are affected by these