Rheumatoid Arthritis Flashcards
What structures does rheumatoid arthritis affect?
any synovial joint- both articular and extra-articular structures
What is rheumatoid arthritis?
symmetrical inflammatory arthritis affecting mainly peripheral joints
Who does rheumtaoid arthritis affect?
any age group; M:F is 1:3
What is RA mediated by?
HLA-DR4
What causes RA?
unknown but potential triggers: infections; stress; cigarette smoking
What are the synovial joints in the body?
C1/C2 in spine; hands joints; wrists; elbows; shoulders; TMJs; knees; hips; ankles
What is a pannus?
formation of granulation/fibrovascular tissue at the edges of synovial lining
What cytokines do macrophages produce in RA?
TNF-alpha; IL-1; IL-6
What do B cells produce in RA?
RF; IL-6
What do IL-6; TNF; IL-1; made by macrophages and B cells stimulate chondrocytes to produce?
matrix- metalloproteinases
Why do the distal interphalangeal joints tend not to be affected by RA?
not enough synovium in that joint
What is early RA defined as?
less than 2 years since symptom onset
Why are the first 3 months of RA critical?
therapeutic window of opportunity
What are the 1987 criteria for RA?
morning stiffness; arthritis of 3 or more joint areas; arthritis of hand joints; symmetric arthritis; rheumatoid nodules; serum RF; radiographic changes
Why is the 1987 criteria for RA outdated?
not all pts get rheumatoid nodules; RF is not always present; radiographic changes only in later disease etc
What are the 4 areas in the 2010 criteria for RA?
joint distribution
serology (RF and ACPA)
symptom duration (more or less than 6 weeks)
acute phase reactants (CRP and ESR)
Why is there morning stiffness with RA?
increased synovial viscosity
What is the squeeze test?
positive cmopression (squeeze) test of metacarpophalngeal and metatarsophalangeal joints
What is trigger finger?
inflam around tendon sheaths of finer means finger gets stuck bent
What hspprnd in carpal tunnel syndrome?
compression of medial nerve in the wrist; thumb, index and middle finer are numb and painful
What is palindromic rheumatism?
variant of RA which is episodic and can progress to RA; more commonly caused by gout and pseudogout
What are the systemic symptoms seen in RA?
weight loss
night sweats
anorexia
rheumatoid cachexia
What are the 2 auto-antibodies seen with RA?
rheumatoid factor (IgM) antibodies to cyclic citrullinated peptide
Why is it pointless to continue testing antibodies?
antibodies remain positive despite treatment
What is seen on X-ray of RA?
soft tissue swelling; periarticular osteopaenia; erosions
What is osteopenia?
decrease in bone density- blacker bone, due to increase in osteoclastic activity
What is the disadvantage of X-rays?
absence of findings in early disease
What is US good for?
increased sensitivity for synovitis in early disease
When are NSAIDs and steroids used in the treatment of RA?
adjuncts; as DMARDs take 6 weeks to work so NSAIDs and steroids help manage symptoms
What is first line DMARD in RA treatment?
methotrexate
What 3 drugs are used in combination therapy?
methotrexate; sulfasalazine; hydroxychloroquine
Why do you need to do a baseline CXR before starting a pt on methotrexate?
risk of pneumonitis
Why do LFTs have to be monitored regularly?
the DMARDs can all cause hepatotoxicity
What should be discussed with females before starting DMARDs?
drugs are teratrogenic
When should sulfasalzine be avoided?
in septrin allergy and G6PD deficiency
What are the biologic agents that can be employed in RA?
anti-TNF; T cell receptor blockers; B cell depletor; IL 6 blocker
What do you have to screen for before starting a pt on biologic agents?
TB; hep B; hep C; HIV; varicella zoster
What can happen to the spine in severe RA?
atlanto-axial subluxation
Why can RA cause mortality?
accelerated CVS disease
