Rheumatoid Arthritis Flashcards
What is rheumatiod arthritis (RA).
A systemic chronic autoimmune disorder affecting the synovial joints with extra-articular manifestations.
It is characterized by a symmetrical, deforming, peripheral polyarthritis.
What is the prevalence of RA. (2)
1-3%.
increased prevalence in smokers
Who is at greater risk of developing RA.
Women are at greater risk than men.
2:1 women:men.
What is the peak age of onset of RA.
50-60.
What are the typical symptoms of RA. (10)
Joint pain exacerbated by movement.
Symmetrical swollen, painful and stiff small joints of the hands and feet.
Joint pain worse in the morning.
There may be large joint involvement.
Extra articular manifestations.
Systemic symptoms: fever (mild), anorexia, malaise, weight loss, lethargy.
What are the clinical signs of RA. (10)
Joints: swollen, warm, tender joints. Joint deformities: swan neck, boutonniere, subluxation. Lymphadenopathy. Splenomegaly. Rheumatoid nodules. Muscle weakness. Look for tenosynovitis or bursitis. Evidence of amyloidosis and vasculitis. Later: ulnar deviation of the fingers and dorsal wrist subluxation. Hand extensor tendons may rupture.
What are the possible joint deformities in RA. (3)
Swan neck.
Boutonniere.
Subluxation.
What is a swan neck deformity. (2)
Hyperextension at PIP.
Flexion deformity at DIP.
What is a boutonniere deformity. (2)
Hyperextension at DIP.
Flexion deformity at PIP.
What is the mnemonic to remember the diagnosis criteria for RA.
RF RISES.
How many criteria are needed to make a positive diagnosis of RA.
4 out of 7.
What are the criteria to make a positive diagnosis of RA. (7)
Rheumatoid factor. Finger/hand joint involvement. Rheumatoid nodules. Involvement of 3 or more joints. Stiffness- early morning. Erosions/decalcification on Xrays. Symmetrical arthritis.
What tests should be carried out if RA is suspected. (4)
Blood tests.
Immunological tests.
Synovial fluid tests.
Xrays.
What is seen in the blood of a patient with RA. (6)
ESR and CRP (indication of the degree of synovial inflammation).
Anaemia of chronic disease.
Low albumin (correlates directly with disease severity).
Neutropenia (in Felty’s syndrome).
High platelets.
What should be tested immunologically if RA is suspected. (2)
Rheumatoid factor (RhF, positive in 70%). Anti-CCP (cyclic citrullinated peptide) antibody (may be a better predictor of progression to erosive join disease than titres of RhF, anti-CCP is highly specific).
What is seen in the Xrays of a patient with RA. (6)
Soft tissue swelling. Joint space narrowing. Peri-articular osteoporosis. Bony erosions. Deformities. Atlanto-axial subluxation.
What is seen in the synovial fluid of a patient with RA. (2)
Raised WCC.
Raised protein.
What are the goals of treatment of RA. (3)
Pain relief.
Protection of remaining articular structure.
Maintenance of function.
What are the three main aspects of treatment of RA. (3)
Patient education.
Physiotherapy and occupational therapy.
Medical.
What is involved in patient education in RA. (2)
Encourage rest alternating with exercise.
What is involved in the medical treatment for RA. (4)
Analgesics.
NSAIDs.
Glucocorticoids.
DMARDs (disease modifying antirheumatic drugs).
What are some non-biological DMARDs. (6)
Methotrexate. Hydroxychloroquine. Sulfasalazine. Leflunomide. Penicillamine. Gold.
What are some biological DMARDs. (3)
Soluble interleukin-1 receptor therapy.
Tumour necrosis factor inhibitors.
Cytotoxic agents.
Give an example of an IL-1 receptor drug used to treat RA.
Anakinra.
Give examples of a TNF inhibitor used to treat RA. (2)
Etanercept.
Infliximab.
Give examples of cytotoxic agents used to treat RA. (3)
Azathioprine.
Cyclophosphamide.
Ciclosporin A.
What complications can occur in RA. (5)
CNS. Respiratory. CVS. Eyes,. Other.
What respiratory complications can arise in RA. (5)
Pulmonary nodules. Fibrosing alveolitis. Pleural effusion. Caplan's syndrome (RA in coal miners with pneumoconiosis). Bronchiolitis obliterans.
What are the CVS complications that can arise in RA. (4)
Endocarditis.
Myocarditis.
Pericarditis.
Nodules.
What are the CNS complications that can arise in RA. (2)
Entrapment neuropathies.
Peripheral neuropathy.
What are the complications of RA that can arise in the eyes. (4)
Episcleritis.
Scleritis.
Kerato-conjunctivitis.
Scleromalacia.
What other complications can arise in RA.
Felty’s syndrome.
What is Felty’s syndrome. (3)
RhF positive.
Splenomegaly.
Neutropenia.
What is the prognosis for patients with RA.
Variable.
What are the poor prognostic factors for RA. (6)
Systemic involvement. Insidious onset. Rheumatoid nodules. RhF > 1:512 Persistent activity for >12 months. Early bone erosions.
What are the less typical presentations of RA. (6)
Sudden onset, widespread arthritis.
Recurring mono/polyarthritis of various joints.
Persistent monoarthritis (often knee, shoulder or hip).
Systemic illness with extra-articular symptoms.
Polymyalgic onset.
Recurrent soft tissue problems.
What are some of the extra-articular presentations of RA. (6)
Fatigue. Fever. Weight loss. Pericarditis. Pleurosity. initially few joint problems (commoner in men).
What are the potential soft tissue problems that can occur in RA. (3)
Frozen shoulder.
Carpal tunnel syndrome.
De Quervain’s tensynovitis.
What are some of the extra-articular signs of RA. (16)
Nodules - elbows and lungs. Lymphadenopathy. Vasculitis.. Fibrosing alveolitis. Obliterative bronchiolitis. Pleural and pericardial effusion. Raynaud's. Carpal tunnel syndrome. Periphera neuropathy. Splenomegaly (5%, only 1% have Felty's syndrome).. Episcleritis. Scleritis. Scleromalacia. Keratoconjunctivitis sicca. Osteoporosis. Amyloidosis.
What is Felty’s syndrome. (3)
RA.
Neutropenia.
Splenomegaly.
How is disease progression in RA measured. (2)
DAS28.
Aim to reduce score to
What are some steroids often used in the treatment of RA. (2)
Methylprednosoline.
Prednisolone.
What are steroids used for in RA.
Usually to treat ‘acute exacerbations’.
What is the first line treatment for RA.
DMARDs.
What are the four aspects of RA diagnosis. (4)
Joint involvement.
Serology.
Acute phase reactants.
Duration of symptoms.
What are some side effects of biological agents to treat RA. (5)
Reactivation of TB and hepatitis B.
Worsening heart failure.
Hypersensitivity.
Injection site reactions and blood disroders.
ANA and reversible SLE type illness may evolve.
