Rheumatoid arthritis

Question 1

what is RA

Answer 1

chronic system autoimmune disorder causing a symmetrical polyarthritis
disease of synovial joints

Question 2

who does RA affect

Answer 2

F before menopause = 3x more likely than M
equal after menopause
FHx
Genetic

Question 3

pathogenesis RA

Answer 3

Factors produced by t cells, macrophages, mast cells and fibroblasts contribute to the ongoing synovial inflammation

Local production of rheumatoid factor (autoantibodies directed against the Fc portion of immunoglobulin) by B cells & formation of immune complexes w/ complement activation also maintain chronic inflammation

Question 4

pathology RA

Answer 4

• synovitis (inflammation of synovial lining of joints)
• infiltration of synovial lining by inflam cells
• generation of new synovial blood vessels
• synovium proliferates and grows out over the surface of cartilage, producing a tumour like mass called a ‘pannus’ which destroys the articular cartilage and subchondral bone

Question 5

3 types of bone loss RA

Answer 5

focal erosion in joint
periarticular osteoporosis
generalised osteoporosis in skeleton

Question 6

clinical features RA

Answer 6

insidious onset of pain
early morning stiffness >30min
swelling in small joints of hands and feet
boutonniere and swan neck deformities in hand
joint effusions and wasting of muscles around joint = early features

Question 7

investigations RA

Answer 7

blood count - normochromic, normocytic anaemia & thrombocytosis. ESR and CRP raised

serum autoantibodies - anti CCP has high specificity and sensitivity for RA
Rheum factor +ve

XR- soft tissue swelling in early disease & later joint narrowing and erosions

synovial fluid is sterile with a high neutrophil count in uncomplicated disease

Question 8

in a suddenly painful joint what should be suspected

Answer 8

septic arthritis

Question 9

rx RA

Answer 9

no cure so is therapeutic
stop smoking
NSAIDs and coxibs - slow relief diclofenac taken at night = dramatic relief next day
corticosteroids suppress disease activity
DMARDs

Question 10

DMARDs?

mech of ac?

Answer 10

disease modifying anti-rheumatic drugs
inhibit inflam cytokines and are used early to reduce inflam and its effects
TNF-a inhibitors - etanercept, infliximab etc - first line treatment