Rheumatoid arthritis Flashcards
What is RA?
Chronic systemic inflammatory disease
Potentially deforming
Symmetrical polyarthritis
Most common seropositive inflammatory arthropathy
Give 3 epidemiologic features of RA
Mainly affects people aged 30-50
F:M ratio is 3:1
Incidence in UK ~ 20 000 annually
Describe the pathogenesis of RA
- inflammation of synovium
- causes release of cytokines into synovial fluid
- fluid eats away at cartilage
Which sites are most commonly affected by RA?
Hands: MCPs and PIPs, wrist
Small joints of feet
Larger joints affected as disease progresses
Which haematological syndrome is found in some patients with RA?
Feltes syndrome
- splenomegaly + destruction of cellular components of blood
What is characteristic of morning stiffness associated with RA?
Lasts longer than 1hr
What type of deformity is common in the hands of patients with RA?
Ulnar devation of phalangeal joints
Swan necking
List 5 extra-articular features of RA
Respiratory - pulmonary fibrosis Neurological Skin - vasculitis Eye - dry eye (and mouth) Haematological - Feltes
Which 3 investigations are used to test for RA?
Anti-CCP
Inflammatory markers e.g. CRP
Hb (anaemia)
Name 4 complications of RA
Infection (2y to immobility)
Atlanto-axial subluxation
ILD
Peripheral neuropathy
Which joints in the hands are spared with RA?
DIPs
Where on the body do rheumatoid nodules normally occur?
Extensor surfaces
Give 3 examples of commonly used DMARDs
Methotrexate!
Sulfasalazine
Hydroxychloroquine
Leflunamide
What is the disadvantage of DMARDs
Slow acting - takes months for effect to set in
How is the lag phase of DMARDs covered?
Prescribe corticosteroid treatment to patient, then titre down steroids and remain on DMARDs
