Rheumatoid Arthritis Flashcards
Define rheumatoid arthritis.
Autoimmune disease causing a symmetrical, small joint, inflammatory polyarthropathy
Describe the clinical features of RA in the joints. (5)
Joint inflammation (synovitis) Spongy swelling of joints Joint effusion Small joint distribution Hand deformities
Which joints are especially affected by RA? (3)
Small joints, esp.
Metacarpophalangeal joints (MCPs) Proximal interphalangeal joints (PIPs)
List 5 types of hand deformity seen in RA.
Ulnar deviation
Muscle wasting
Z-thumb
Boutonniere deformity (fixed flexion of PIP, fixed extension of the DIP)
Swan-neck deformity (fixed extension of PIP, fixed flexion of DIP)
List 11 features of RA outside of joints.
Rheumatoid nodules Stroke Ischaemic heart disease Lymphoma Scleritis Compression myelopathy Pulmonary fibrosis Serositis Anaemia Amyloidosis Peripheral neuropathy
What is RA caused by?
Give 2 examples.
Genetic predisposition, e.g.
- HLA DR4
- Shared epitope (HLA-DRB1)
List 4 risk factors for RA.
Mediterranean diet (loads of omega 3/fatty fish)
Smoking
Infections
Microbiome
What investigations would you do for RA? (3)
Bloods
X-ray
DAS28 score
What blood tests you would you do for RA? (4)
FBC
CRP/ESR
Rheumatoid factor (autoantibody against Fc component of other antibodies)
Anti-CCP antibodies (ACPA)
What are the features of RA on x-ray? (6)
Soft tissue swelling Juxta-articular osteopenia Decreased joint space Bony erosions Subluxation Carpal destruction
What is Felty’s syndrome?
RA + splenomegaly + neutropenia
How would you measure the severity of RA?
Describe this system. (4)
DAS28 (disease activity score)
Takes into account:
- Number of swollen joints (out of 28)
- Number of tender joints (out of 28)
- Bloods (esp. CRP/ESR)
- Patient’s opinion of their general health from very good to very bad
Describe the results of the DAS28 scale.
5.1+ - active disease
<3.2 - low disease activity
<2.6 - remission
How would you treat RA? (7)
Analgesia Corticosteroids DMARDs Anti-TNF drugs Multi-disciplinary team Occupational therapy Surgery
What sort of analgesia would you give in RA? Give some examples of this time of painkiller.
NSAIDs, e.g.
- Ibuprofen
- Diclofenac
List 5 side effects of NSAIDs.
Gastritis GI/duodenal ulceration Renal impairment Bronchospasm LFT derangement
Give 3 examples of DMARDs.
Methotrexate
Sulfasalazine
Hydroxychloroquine
List 7 side effects of DMARDs.
Increased susceptibility to infection Headache GI ulceration Rash Abnormal FBC, U&Es, LFTs Pneumonitis Retinal disease
List the important pharmacokinetics/dynamics of DMARDs. (4)
Slow acting (2-3 months before effect)
Requires regular blood monitoring
Requites annual optic screening
Requires flu and pneumococcal vaccines
Give 5 examples of anti-TNF drugs.
Infliximab Etanercept Adalimumab Certolizumab Golimumab
List 5 side effects of anti-TNF drugs.
Increased susceptibility to infection (esp. reactivation of TB) Pulmonary fibrosis Increased risk of malignancy Demyelination disorders Anti-drug antibodies
Apart from anti-TNF drugs, which other biologic therapies can be used for RA? (4)
Rituximab (anti-B cell)
Tocilizumab (anti-IL6)
Abatacept (co-stimulation blockade)
Tofactinib (JAK/STAT inhibition)
Who is in the MDT for RA? (6)
Physiotherapist Occupational therapist Specialist nurses Podiatry Orthotics GP
