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MSK- Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is the main stucture involved in Rheumatoid Arthritis?

A

The synovium

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2
Q

What is defined as Early Rheumatoid Arthritis?

A

Within 2 years of symptom onset

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3
Q

What are the classical clincial features of Rheumatoid Arthritis?

A

Prolonged Morning stiffness

Involvement of small joints of the hands and feet

Symmetical distribuion

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4
Q

What are the two key auto antibodies in Rheumatoid Arthritis?

A

Rheumatoid Factor

Anti-CCP

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5
Q

Why is Anti-CCP more useful than Rheumatoid factor?

A

Anti-CCP is 90-99% specific

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6
Q

What is important to know about Anti - CCP?

A

Can be present before disease

Co-relates with disease activity

Absence does not exclude disease

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7
Q

What are the Cut offs for the DAS28 scoring system?

A

< 2.6 remission

  1. 6-3.2 Low disease
  2. 2- 5.1 Moderate disease

>5.1 Active disease

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8
Q

What is the main stay treatment for Inflammatory Arhropathies

A

Analgesia

Steroids
Disease modifiying anti rheumatic drugs

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9
Q

What does Seropositive and Seronegative mean?

A

Seropositive means there are auto-antibodies in the blood

Seronegative means that there are no auto-antibodies in the blood

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10
Q
A
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11
Q

What are the categories of Arthrities?

A

Non- inflammatory

Inflammatory - seropostitive and seronegative

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12
Q

What does seropositive mean?

A

Auto-antibodies in serum

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13
Q

What is the most common form of arthritis?

A

Osteoarthritis

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14
Q

What factors contribute to your risk of Osteoarthritis?

A

Hobbies

Abnormal Joint alignmeant

Previous injuries

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15
Q

What are the typical radiograph findings of a osteoarthritic joint?

A

Loss of joint space

Osteophytes

Sclerosis

Subchondral cysts

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16
Q

What is Sclerosis ?

A

Hardening of bone

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17
Q

What is the usual management of oseteoarthritis?

A

Pain relief

simple analgesia and opiates

Surgery if appropriate

Physiotherapy and weight loss

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18
Q

What are the four groups of inflammatory arthropathies?

A

Seropositive

Seronegative

Infectious

Crystal deposition disorders

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19
Q

What are some classical feauters of Inflammatory Arthritis?

A

Joint pain and swelling

Morning stiffness which eases off with movement

Synovitis

Raised inflammatory markers

Extra-articular symptoms

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20
Q

What is the pathogenesis of rheumatoid arthritis?

A

Auto-immune response initiated against synovium

An infllammatory panus forms which then attacks the articular cartilage leading to joint destruction

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21
Q

How is a diagnosis of Rheumatoid Arthritis made?

A

combination of :

Clinical presentation

radiograph findings

serological analysis

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22
Q

What joints in the hand are affected by rheumatiod arthritis?

A

Wrist joint

MCP and PIP

NOT DIP (no synovium)

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23
Q

What can long standing cervial rheumatoid arthritis cause?

A

Atlanto-axial subluxation resulting in cervical cord compression

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24
Q

What are Rheumatoid Nodules?

A

They occour in 25% of people with rheumatoid arthritis

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25
Q

What are the two Auto-antibodies measured in rheumatoid arthritis?

A

Rheumatoid Factor

and

Anti-CCP

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26
Q

Which auto-antibody is more specific in rheumatoid arthritis?

A

Anti CCP

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27
Q

What perecentage of people with rheumatoid arthritis are Sero-negative?

A

20%

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28
Q

Other than auto-antibodies, what else might you find in blood tests?

A

CRP, ESR and Plasma Viscosity is raised.

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29
Q

What is ESR?

A

Erythromyte sedementation rate

30
Q

What is the goal in treating rheumatoid arthritis?

A

Relieve symptoms

Slow down disease progression

31
Q

What is the “golden window” with regards to rheumatoid arthritis?

A

DMARDs should be started within 3 months of the onsent of symptoms

32
Q

What is the first line DMARD for rheumatoid Arthritis?

A

Methotrexate

33
Q

Name four DMARDs for use in rheumatoid Arthritis?

A

Methotrexate

Sulphasalazine

Hydroxycholroquine

Leflunomide

34
Q

What must you be aware about when prescribing DMARDs?

A

They can cause bone marrow suppression and immune supression

Regular blood monitoring is a must

35
Q

What can you use in Rheumatoid arthritis if DMARDs arent working?

A

Biologics injection

anti-TNF alpha drugs

36
Q

Name 3 biologics used in rheumatoid Arthritis

A

Toclizumab

Ritximab

Abatacept

37
Q

What must you be aware of when using biologics in rheumatoid arthritis?

A

They cause and inceased risk of infection; especially to TB

38
Q

What are the cut offs in the DAS 28 score?

A

< 2.6 : remission

  1. 7 - 3.1 : low disease activity
  2. 1 - 5.1 : moderate disease activity

> 5.1 : high disease activity

39
Q

What must the DAS 28 score be in order to be eligible for biologic therapy?

A

High disease activity

>5.1

40
Q

What alternative therapies can be usueful in rheumatoid arthritis?

A

allied health professionals

Synovectom

Joint replacement

Joint excision

Arthrodesis

Cevical spine stabilisation

41
Q

What are the categories of Arthrities?

A

Non- inflammatory

Inflammatory - seropostitive and seronegative

42
Q

What does seropositive mean?

A

Auto-antibodies in serum

43
Q

What is the most common form of arthritis?

A

Osteoarthritis

44
Q

What factors contribute to your risk of Osteoarthritis?

A

Hobbies

Abnormal Joint alignmeant

Previous injuries

45
Q

What are the typical radiograph findings of a osteoarthritic joint?

A

Loss of joint space

Osteophytes

Sclerosis

Subchondral cysts

46
Q

What is Sclerosis ?

A

Hardening of bone

47
Q

What is the usual management of oseteoarthritis?

A

Pain relief

simple analgesia and opiates

Surgery if appropriate

Physiotherapy and weight loss

48
Q

What are the four groups of inflammatory arthropathies?

A

Seropositive

Seronegative

Infectious

Crystal deposition disorders

49
Q

What are some classical feauters of Inflammatory Arthritis?

A

Joint pain and swelling

Morning stiffness which eases off with movement

Synovitis

Raised inflammatory markers

Extra-articular symptoms

50
Q

What is the pathogenesis of rheumatoid arthritis?

A

Auto-immune response initiated against synovium

An infllammatory panus forms which then attacks the articular cartilage leading to joint destruction

51
Q

How is a diagnosis of Rheumatoid Arthritis made?

A

combination of :

Clinical presentation

radiograph findings

serological analysis

52
Q

What joints in the hand are affected by rheumatiod arthritis?

A

Wrist joint

MCP and PIP

NOT DIP (no synovium)

53
Q

What can long standing cervial rheumatoid arthritis cause?

A

Atlanto-axial subluxation resulting in cervical cord compression

54
Q

What are Rheumatoid Nodules?

A

They occour in 25% of people with rheumatoid arthritis

55
Q

What are the two Auto-antibodies measured in rheumatoid arthritis?

A

Rheumatoid Factor

and

Anti-CCP

56
Q

Which auto-antibody is more specific in rheumatoid arthritis?

A

Anti CCP

57
Q

What perecentage of people with rheumatoid arthritis are Sero-negative?

A

20%

58
Q

Other than auto-antibodies, what else might you find in blood tests?

A

CRP, ESR and Plasma Viscosity is raised.

59
Q

What is ESR?

A

Erythromyte sedementation rate

60
Q

What is the goal in treating rheumatoid arthritis?

A

Relieve symptoms

Slow down disease progression

61
Q

What is the “golden window” with regards to rheumatoid arthritis?

A

DMARDs should be started within 3 months of the onsent of symptoms

62
Q

What is the first line DMARD for rheumatoid Arthritis?

A

Methotrexate

63
Q

Name four DMARDs for use in rheumatoid Arthritis?

A

Methotrexate

Sulphasalazine

Hydroxycholroquine

Leflunomide

64
Q

What must you be aware about when prescribing DMARDs?

A

They can cause bone marrow suppression and immune supression

Regular blood monitoring is a must

65
Q

What can you use in Rheumatoid arthritis if DMARDs arent working?

A

Biologics injection

anti-TNF alpha drugs

66
Q

Name 3 biologics used in rheumatoid Arthritis

A

Toclizumab

Ritximab

Abatacept

67
Q

What must you be aware of when using biologics in rheumatoid arthritis?

A

They cause and inceased risk of infection; especially to TB

68
Q

What are the cut offs in the DAS 28 score?

A

< 2.6 : remission

  1. 7 - 3.1 : low disease activity
  2. 1 - 5.1 : moderate disease activity

> 5.1 : high disease activity

69
Q

What must the DAS 28 score be in order to be eligible for biologic therapy?

A

High disease activity

>5.1

70
Q

What alternative therapies can be usueful in rheumatoid arthritis?

A

allied health professionals

Synovectom

Joint replacement

Joint excision

Arthrodesis

Cevical spine stabilisation

MSK- Rheumatology (8 decks)

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