Rheumatoid arthritis

Question 1

How is rheumatoid arthritis defined?

Answer 1

Chronic, systemic inflammatory disease which is characterised by symmetrical polyarthritis and systemic disease

Question 2

Who is RA most prevalent in?

Answer 2

Females 30-50

Question 3

What are the changes at the joint level that RA causes?

Answer 3

Inflammation of tendon sheath

Inflammation of synovial membrane

Question 4

What cells infiltrate the synovial fluid?

Answer 4

Macrophages, fibroblasts

Question 5

What is a fibroblast?

Answer 5

Produces collagen

Question 6

What happens to the synovial membrane in RA?

Answer 6

Expands and actively erodes bone and cartilage

Question 7

What are common symptoms of RA?

Answer 7

Stiffness- especially in the morning.
Joint pain and swelling
Malaise, fatigue.

Question 8

What are the common sites of RA?

Answer 8

All metacarpal and tarsal joints are the most common. 
MCPs and PIPs but NOT DIPs. 
Shoulders
Elbows
Wrists

Question 9

What is the treatment for RA?

Answer 9

Early introduction of DMARDs with steroids

Question 10

What are examples of DMARDs?

Answer 10

Methotrexate. sulfsalazine, hydroxychlororquine,

Question 11

Which DMARD is first line?

Answer 11

Methotrexate.

Remember this requires regular LFT monitoring

Question 12

Why do RA sufferers have a reduced life expectancy?

Answer 12

CInfection - immobility, bed sores etc.
Cervical myelopathy e.g. at atlanto-axial or sub-axial
ILD
Peripheral neuropathy

Question 13

What investigations will you do if RA is suspected?

Answer 13

Anti-CCP Ab
Rheumatoid factor (RF)
Radiography - USS then x-ray if needed.

Question 14

What are you looking for in a history?

Answer 14

Already have active arthritis
Joint pain
Joint swelling
Stiffness in the morning.

Question 15

What does the word arthritis mean?

Answer 15

Inflammation of a joint

Question 16

What does arthropathy mean?

Answer 16

Disease of a joint

Question 17

What are the two types of arthritis?

Answer 17

Non-inflammatory

Inflammatory

Question 18

How are inflammatory arthritis divided?

Answer 18

Seropositive arthritis e.g. RA and connective tissue diseases

Seronegative i.e. no antibodies in serum

Question 19

What is the disease process which causes the degradation of the synovium?

Answer 19

An immune response, ? from smoking, infection or trauma, that is triggered and inflames the synovium.

Question 20

What are the possible consequences, at joint level, of RA?

Answer 20

Tendon ruptures and soft tissue damage occurs which leads to joint instability and subluxation

Question 21

True or False

CRP and ESR are normal in RA.

Answer 21

False.

Usually raised.

Question 22

What is the significance if RA affects the cervical spine?

Answer 22

Atlanto-axial subluxation could occur and lead to cervical cord compression.

Question 23

What extra-articular manifestations can be found?

Answer 23

Rheumatoid nodules on extensor surfaces
Lung involvement- pleural effusions,interstitial fibrosis
Episcleritis and uveitis also common.

Question 24

Which is the first line investigation?

Answer 24

Anti-CCP as it is more specific

Question 25

If the patient does not respond to DMARDs, what is the next line?

Answer 25

Biologics, specifically anti- TNF alphas like rituximab

Question 26

What disease is a real risk when using anti-TNF alphas?

Answer 26

Reemergence of TB