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MSK > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What structures does rheumatoid arthritis affect?

A

any synovial joint- both articular and extra-articular structures

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2
Q

What is rheumatoid arthritis?

A

symmetrical inflammatory arthritis affecting mainly peripheral joints

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3
Q

Who does rheumtaoid arthritis affect?

A

any age group; M:F is 1:3

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4
Q

What is RA mediated by?

A

HLA-DR4

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5
Q

What causes RA?

A

unknown but potential triggers: infections; stress; cigarette smoking

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6
Q

What are the synovial joints in the body?

A

C1/C2 in spine; hands joints; wrists; elbows; shoulders; TMJs; knees; hips; ankles

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7
Q

What is a pannus?

A

formation of granulation/fibrovascular tissue at the edges of synovial lining

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8
Q

What cytokines do macrophages produce in RA?

A

TNF-alpha; IL-1; IL-6

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9
Q

What do B cells produce in RA?

A

RF; IL-6

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10
Q

What do IL-6; TNF; IL-1; made by macrophages and B cells stimulate chondrocytes to produce?

A

matrix- metalloproteinases

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11
Q

Why do the distal interphalangeal joints tend not to be affected by RA?

A

not enough synovium in that joint

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12
Q

What is early RA defined as?

A

less than 2 years since symptom onset

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13
Q

Why are the first 3 months of RA critical?

A

therapeutic window of opportunity

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14
Q

What are the 1987 criteria for RA?

A

morning stiffness; arthritis of 3 or more joint areas; arthritis of hand joints; symmetric arthritis; rheumatoid nodules; serum RF; radiographic changes

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15
Q

Why is the 1987 criteria for RA outdated?

A

not all pts get rheumatoid nodules; RF is not always present; radiographic changes only in later disease etc

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16
Q

What are the 4 areas in the 2010 criteria for RA?

A

joint distribution
serology (RF and ACPA)
symptom duration (more or less than 6 weeks)
acute phase reactants (CRP and ESR)

17
Q

Why is there morning stiffness with RA?

A

increased synovial viscosity

18
Q

What is the squeeze test?

A

positive cmopression (squeeze) test of metacarpophalngeal and metatarsophalangeal joints

19
Q

What is trigger finger?

A

inflam around tendon sheaths of finer means finger gets stuck bent

20
Q

What hspprnd in carpal tunnel syndrome?

A

compression of medial nerve in the wrist; thumb, index and middle finer are numb and painful

21
Q

What is palindromic rheumatism?

A

variant of RA which is episodic and can progress to RA; more commonly caused by gout and pseudogout

22
Q

What are the systemic symptoms seen in RA?

A

weight loss
night sweats
anorexia
rheumatoid cachexia

23
Q

What are the 2 auto-antibodies seen with RA?

A 
rheumatoid factor (IgM)
antibodies to cyclic citrullinated peptide
24
Q

Why is it pointless to continue testing antibodies?

A

antibodies remain positive despite treatment

25
Q

What is seen on X-ray of RA?

A

soft tissue swelling; periarticular osteopaenia; erosions

26
Q

What is osteopenia?

A

decrease in bone density- blacker bone, due to increase in osteoclastic activity

27
Q

What is the disadvantage of X-rays?

A

absence of findings in early disease

28
Q

What is US good for?

A

increased sensitivity for synovitis in early disease

29
Q

When are NSAIDs and steroids used in the treatment of RA?

A

adjuncts; as DMARDs take 6 weeks to work so NSAIDs and steroids help manage symptoms

30
Q

What is first line DMARD in RA treatment?

A

methotrexate

31
Q

What 3 drugs are used in combination therapy?

A

methotrexate; sulfasalazine; hydroxychloroquine

32
Q

Why do you need to do a baseline CXR before starting a pt on methotrexate?

A

risk of pneumonitis

33
Q

Why do LFTs have to be monitored regularly?

A

the DMARDs can all cause hepatotoxicity

34
Q

What should be discussed with females before starting DMARDs?

A

drugs are teratrogenic

35
Q

When should sulfasalzine be avoided?

A

in septrin allergy and G6PD deficiency

36
Q

What are the biologic agents that can be employed in RA?

A

anti-TNF; T cell receptor blockers; B cell depletor; IL 6 blocker

37
Q

What do you have to screen for before starting a pt on biologic agents?

A

TB; hep B; hep C; HIV; varicella zoster

38
Q

What can happen to the spine in severe RA?

A

atlanto-axial subluxation

39
Q

Why can RA cause mortality?

A

accelerated CVS disease

MSK (39 decks)

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