Rheumatoid Arthritis

Question 1

What is rheumatoid arthritis?

What is it, whats its distribution, what does it effect?

Answer 1

Chronic autoimmune systemic illness characterised by a symmetrical peripheral arthritis and other systemic symptoms

Question 2

If rheumatoid arthritis goes untreated what 3 things can it be associated with?

Answer 2

Joint damage
Disability
Premature mortality

Question 3

Is rheumatoid more likely with one joint effected, a couple of joints or many joints?

Answer 3

Polyarteritis

Question 4

What duration of symptoms make rheumatoid arthritis more common?

Answer 4

6 weeks or more

Question 5

What is the epidemiology of rheumatoid arthritis?

Answer 5

Prevalence:
-Approx 1% of pop

M:F -> 1:3

Age of onset:
-Peak age 4th/5th decade but may occur at any age from 16 years

Question 6

What is the aetiology of rheumatoid arthritis?

Answer 6

Genetic

Environmental

• Smoking
• Chronic infection (e.g. periodontal disease)

Question 7

What is the pathology of rheumatoid arthritis?

Answer 7

Synovitis

• inflammed synovial membrane
• thickening
• thinning of cartilage
• inflammatory cell infiltration

Question 8

What serology tests can you do in rheumatoid arthritis?

Answer 8

Rheumatoid factor (IgG, IgM)

Anti Cyclic Citrullinated Antibodies (anti CCP, ACPA)

Question 9

What imaging studies can you use in rheumatoid arthritis investigation?

Answer 9

X-ray

• Joint space narrowing
• Joint errosion
• Destruction of bones around joint

Ultrasound Doppler
-Shows inflammation

Question 10

What are the symptoms of arthritis?

Answer 10

Pain
Stiffness
Immobility
Poor function
Systemic Symptoms

Question 11

What are the clinical signs of arthritis?

Answer 11

Swelling
Tenderness
Limitation of movement
(Redness)
(Heat)

Question 12

Where does joint pain usually occur first in rheumatoid arthritis?

Answer 12

Distal small joints

• (hands and feet)
• symmetrical

Question 13

What are the systemic features of rheumatoid arthritis?

non-specific, specific and long term

Answer 13

Non-specific

• Fatigue
• Weight loss
• Anaemia

Specific

• Eyes
• Lungs
• Nerves
• Skin
• Kidneys

Long term
-CVS, malignancy

Question 14

How common are rheumatoid nodules?

Answer 14

Up to 20% of patients will have them.

May indicate worse disease

Question 15

How can you assess the activity of rheumatoid arthritis?

any scoring system?

Answer 15

Disease Activity Score

DAS 28

Question 16

What DAS score represents eligibility for biologic therapy?

Answer 16

> 5.1

Question 17

What DAS score represents clinical remission?