Rheumatoid Arthritis Flashcards
What is Rheumatoid Arthritis?
A chronic systemic inflammatory disease, characterised by potentially deforming symmetrical polyarthritis and extra-articular features
Whats is the Female:Male ration of RA?
3:1
What genes are involved in RA?
HLA
DR4
DR1
What happens to the Synovium in RA?`
It becomes laden with macrophages, fibroblasts and multi-nucleated giant cells (resemble osteoclasts)
What does the Synovium membrane (pannus) do in RA?
It expands, actively invading and erodes surrounding bone and cartilage
What are symptoms of RA?
Joint pain, stiffness (esp in morning) joint swelling, mailaise and fatigue etc.
What other systems of the body can be effected by RA?
Respiratory Neurological Dermatology Ophthalmology Hematological
What are signs of RA?
Swelling, tenderness, reduced range of movement, deformities
What eats at the cartilage?
Cytokines
What inflammatory markers should be checked with suspected RA?
PV
CRP
What else should be checked in suspected RA?
Anti CCP (Cyclic Citrullintaed Peptide)
RF (Rheumatoid Factor)
Anaemia
What are some possible late complications of RA?
Infection
Cervical myelopathy
Interstitial lung disease
Peripheral
How long is the “Window of Opportunity” where irreversible damage to the joints can be avoided?
3 months
What are DMARD’s?
Disease Modifying Drugs
What are DMARD’s given with (to cover lag phase)
Steroids
What problems can occur in the eye with RA?
Dry eye due to fibrosis, same process causes dry mouth.
Epi something in the sclera
What problems can occur in the lungs with RA?
Pulmonary fibrosis
Are DMARD’s fast or slow acting?
Slow
What do DMARD’s do?
Reduce rate of joint damage
What other drugs can be given for RA?
Methotrexate Sulfasalazine Leftunamide Hydroxychloroquine, pencillamine, gold
What 5 biological approaches have helped in RA?
- TNF-alpha inhibiton
- B cell depletion
- Disruption of T cell costimulation
- Interleukin-1 and IL-6 inhibition
- Jak2 inhibitors
What drugs help inhibit TNF-alpha?
Inflximab
Adalmumab
Etanercept
What drugs help deplet B cells?
Rituximab
What drugs disrupt T cell costimulation?
Abatacept
What drugs inhibit IL-1 and IL-6?
Anankira for IL-1
Tocilizumab for IL-6
