Rheumatoid arthritis Flashcards
How is rheumatoid arthritis defined?
Chronic, systemic inflammatory disease which is characterised by symmetrical polyarthritis and systemic disease
Who is RA most prevalent in?
Females 30-50
What are the changes at the joint level that RA causes?
Inflammation of tendon sheath
Inflammation of synovial membrane
What cells infiltrate the synovial fluid?
Macrophages, fibroblasts
What is a fibroblast?
Produces collagen
What happens to the synovial membrane in RA?
Expands and actively erodes bone and cartilage
What are common symptoms of RA?
Stiffness- especially in the morning.
Joint pain and swelling
Malaise, fatigue.
What are the common sites of RA?
All metacarpal and tarsal joints are the most common. MCPs and PIPs but NOT DIPs. Shoulders Elbows Wrists
What is the treatment for RA?
Early introduction of DMARDs with steroids
What are examples of DMARDs?
Methotrexate. sulfsalazine, hydroxychlororquine,
Which DMARD is first line?
Methotrexate.
Remember this requires regular LFT monitoring
Why do RA sufferers have a reduced life expectancy?
CInfection - immobility, bed sores etc.
Cervical myelopathy e.g. at atlanto-axial or sub-axial
ILD
Peripheral neuropathy
What investigations will you do if RA is suspected?
Anti-CCP Ab
Rheumatoid factor (RF)
Radiography - USS then x-ray if needed.
What are you looking for in a history?
Already have active arthritis
Joint pain
Joint swelling
Stiffness in the morning.
What does the word arthritis mean?
Inflammation of a joint
What does arthropathy mean?
Disease of a joint
What are the two types of arthritis?
Non-inflammatory
Inflammatory
How are inflammatory arthritis divided?
Seropositive arthritis e.g. RA and connective tissue diseases
Seronegative i.e. no antibodies in serum
What is the disease process which causes the degradation of the synovium?
An immune response, ? from smoking, infection or trauma, that is triggered and inflames the synovium.
What are the possible consequences, at joint level, of RA?
Tendon ruptures and soft tissue damage occurs which leads to joint instability and subluxation
True or False
CRP and ESR are normal in RA.
False.
Usually raised.
What is the significance if RA affects the cervical spine?
Atlanto-axial subluxation could occur and lead to cervical cord compression.
What extra-articular manifestations can be found?
Rheumatoid nodules on extensor surfaces
Lung involvement- pleural effusions,interstitial fibrosis
Episcleritis and uveitis also common.
Which is the first line investigation?
Anti-CCP as it is more specific
If the patient does not respond to DMARDs, what is the next line?
Biologics, specifically anti- TNF alphas like rituximab
What disease is a real risk when using anti-TNF alphas?
Reemergence of TB
