Rheumatoid Arthritis Flashcards
What is the key factor in RA that leads to cartilage and bone destruction
Synovial hypertrophy
What are the key cytokines involved in the pathogenesis of RA
TNF-alpha
Interleukin-1
Which HLA markers are associated with RA, particularly regarding severity
HLA-DR4
HLA-DR1
In a classical presentation of RA, which joints are affected
Symmetrical pattern
MCP PIP Wrists MTP Forefoot joints
What are the severe complications of RA
Atlanto-axial subluxation
Amyloidosis
Pericarditis
Scleritis
What other systems are affected in RA
Haematological Neurological Pulmonary Cardiac Cutaneous Ocular
What are the haematological manifestations of RA
Anaemia
Neutrophilia
Thrombocytosis
Felty’s syndrome
What are the neurological manifestations of RA
Carpal tunnel syndrome
Atlanto-axial subluxation
Peripheral neuropathies
What are the pulmonary manifestations of RA
Pleural effusions
Interstitial lung disease
Bronchiolitis obliterans
What are the cardiac manifestations of RA
Pericarditis Coronary vasculitis (rare)
What are the cutaneous manifestations of RA
Rheumatoid nodules
Peripheral vasculitis
Leg ulcers
Alopecia
What are the ocular manifestations of RA
Dry eye
Scleritis
Episcleritis
What are some other extra-articular manifestations of RA
Dry mouth
Osteoporosis
Muscle wasting
What is bronchiolitis obliterans
Inflammatory obstruction of the bronchioles
What is scleritis
Painful inflammation of the sclera
What are the signs of RA
Subluxation and ulnar deviation at MCPs Subluxation at wrist Swan-neck deformity Boutonniere's deformity 'Z' thumbs Muscle wasting (disuse atrophy) Rheumatoid nodules (elbows)
May have surgical scars:-
Carpal tunnel release
Joint replacement (esp. thumb)
Tendon transfer (dorsum of hand)
What is tendon transfer
Performed to improve lost hand function following tendon rupture
What radiological changes would you expect to find in RA
PALS
Periarticular osteoporosis
Articular erosions
Loss of joint space
Soft tissue swelling
What percentage of patients with RA have a positive RF
80%
What criteria do you use to diagnose RA
American College of Rheumatology Criteria
4/7 needed
What are the American College of Rheumatology Criteria
Morning stiffness for over an hour Arthritis in 3+ joint areas simultaneously Arthritis of hands Symmetrical arthritis Rheumatoid nodules Positive RF Erosions on joint radiographs
What DMARDs are available
Methotrexate Hydroxychloroquine Sulphasalazine Corticosteroids Azathioprine Gold complexes Penicillamine
What are the side effects of methotrexate
Neutropaenia
Pulmonary toxicity
Hepatitis
How would you monitor methotrexate treatment
CXR
FBC
LFT
What are the side effects of hydroxychloroquine
Retinopathy
How would you monitor hydroxychloroquine treatment
Visual acuity
What are the side effects of sulphasalazine
Rash
Bone marrow suppression
How would you monitor sulphasalazine treatment
FBC
What are the side effects of corticosteroids
Osteoporosis Cushings syndrome Hyperglycaemia Stomach ulcers Glaucoma
What are the side effects of gold complexes
Thrombocytopaenia
Rash
How do you monitor gold complex treatment
FBC
What are the side effects of penicillamine
Nephrotic syndrome
Thrombocytopaenia rash
How do you monitor penicillamine treatment
FBC
Urine dip
