Rheumatoid Arthritis Flashcards
What is Rheumatoid Arthritis
A chronic systemic inflammatory disease, characterised by potentially deforming symmetrical polyarthritis and extra articular features (systemic disease)
Who is most likely to get Rheumatoid Arthritis
1% of populaiton
30-50year of age
3:1 female to male ratio
What type of patients are less likely to respond to treatment
People who smoke or have previously smoked
If you have RA you are more likely to get what? Or if you have the other disease you are more likely to get RA. What is the other disease
Bronchiectasis
Describe the structure of a normal joint
Even joint space
Cartilage protecting the bone edges
Synovial membrane containing the synovial fluid
What is the purpose of the synovium
It provides a source of nutrition to the joint - blood vessels and nutrients
What happens within the joint in RA
The synovium proliferates and becomes invasive
The synovium thickens and releases cytokines int the synovial space
The fluid becomes less viscous, thicker and full of cytokines
What is the roll of macrophages in Rheumatoid Arthritis
They eat into the bones and the cartilage and destroy the soft tissue around them.
Joints are lined with synovium. What else is lined with this
Tendon sheaths
Name some of the symptoms of RA
Joint pain
Stiffness (esp. in the morning)
Joint swelling
General symptoms - malaise, fatigue etc.
Name some extra articular features of RA
Respiratory Neurolological skin eye haematological
What are the 3 main signs of RA
Swlling
Tenderness
Reduced range of movement
How do we describe the distribution of RA
Symmetrical polyarthritis
What investigations can we do for RA
Anti CCP (cyclic citrullinated peptide)
Inflamatory markers (PV, CRP)
ANaemia of chronic disease
Radiology - ultrasound
What can ultrasound pick up in early presentation
Synovitis
What are some of the late complications
Infection
Cervical myelopathy (atlanto-axial or sub-axial subluxation)
Interstitial lung disease
Peripheral neuropathy
What impact does RA have on the patient
32 times more likely to stop work on health grounds
Life expectancy reduced by around 10 years
What impact does RA have on the NHS
huge costs directly and indirectly
What are the 3 main comorbidities with RA
Serious infection
Cardiovascular mortality
Lymphoma
What are some of the more poor prognostic indicators
Young age at onset
Male
HLA DR4 positive
many active joints
What is the main aim of treatment in RA
Decrease the pain and joint damage and to prevent joint damage. Hopefully find a cure
How is treatment delivered in RA
Slow acting - cover lag phase with steroids
Reduce rate of joint damage
Initiate as soon as possible
Step up therapy v initial combination therapy
Frequent early review with tailoring of treatment against inflammation
What drug is half as effective as methotrexate
TNF inhibitors
Who all is involved in the care of a patient with RA?
GP Rheumatologist Occupational Therapist Physiotherapist Podiatrist Nurse
