Rheumatoid Arthritis

Question 1

What is Rheumatoid Arthritis

Answer 1

A chronic systemic inflammatory disease, characterised by potentially deforming symmetrical polyarthritis and extra articular features (systemic disease)

Question 2

Who is most likely to get Rheumatoid Arthritis

Answer 2

1% of populaiton
30-50year of age
3:1 female to male ratio

Question 3

What type of patients are less likely to respond to treatment

Answer 3

People who smoke or have previously smoked

Question 4

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

Answer 4

Bronchiectasis

Question 5

Describe the structure of a normal joint

Answer 5

Even joint space
Cartilage protecting the bone edges
Synovial membrane containing the synovial fluid

Question 6

What is the purpose of the synovium

Answer 6

It provides a source of nutrition to the joint - blood vessels and nutrients

Question 7

What happens within the joint in RA

Answer 7

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

Question 8

What is the roll of macrophages in Rheumatoid Arthritis

Answer 8

They eat into the bones and the cartilage and destroy the soft tissue around them.

Question 9

Joints are lined with synovium. What else is lined with this

Answer 9

Tendon sheaths

Question 10

Name some of the symptoms of RA

Answer 10

Joint pain
Stiffness (esp. in the morning)
Joint swelling
General symptoms - malaise, fatigue etc.

Question 11

Name some extra articular features of RA

Answer 11

Respiratory 
Neurolological
skin
eye
haematological

Question 12

What are the 3 main signs of RA

Answer 12

Swlling
Tenderness
Reduced range of movement

Question 13

How do we describe the distribution of RA

Answer 13

Symmetrical polyarthritis

Question 14

What investigations can we do for RA

Answer 14

Anti CCP (cyclic citrullinated peptide)
Inflamatory markers (PV, CRP)
ANaemia of chronic disease
Radiology - ultrasound

Question 15

What can ultrasound pick up in early presentation

Answer 15

Synovitis

Question 16

What are some of the late complications

Answer 16

Infection
Cervical myelopathy (atlanto-axial or sub-axial subluxation)
Interstitial lung disease
Peripheral neuropathy

Question 17

What impact does RA have on the patient

Answer 17

32 times more likely to stop work on health grounds

Life expectancy reduced by around 10 years

Question 18

What impact does RA have on the NHS

Answer 18

huge costs directly and indirectly

Question 19

What are the 3 main comorbidities with RA

Answer 19

Serious infection
Cardiovascular mortality
Lymphoma

Question 20

What are some of the more poor prognostic indicators

Answer 20

Young age at onset
Male
HLA DR4 positive
many active joints

Question 21

What is the main aim of treatment in RA

Answer 21

Decrease the pain and joint damage and to prevent joint damage. Hopefully find a cure

Question 22

How is treatment delivered in RA

Answer 22

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

Question 23

What drug is half as effective as methotrexate

Answer 23

TNF inhibitors

Question 24

Who all is involved in the care of a patient with RA?

Answer 24

GP
Rheumatologist
Occupational Therapist
Physiotherapist
Podiatrist
Nurse