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W224 Rheumatoid arthritis > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A
  • Rheumatoid arthritis is a systemic inflammatory disease/ chronic autoimmune disorder.
  • It is characterised by symmetrical peripheral deforming poly-arthropathies
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2
Q

What lifestyle choice leads to a raised incidence of RA?

A

Smoking

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3
Q

What gene is associated with RA?

A

HLA-DR4/DR1

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4
Q

What is synovitis??

A

Inflammation of the synovial lining of joints, tendon sheeths or bursae.

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5
Q

What is the pathology of RA?

A
  • Synovitis
  • Thickening of the synovial lining
  • Infiltration of inflamatory cells

→ Formation of Pannus

• Pannus destroys the articular cartilage and subchondral bone → bony errosions

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6
Q

What is the typical presentation of RA?

A
  • Symetrical swollen, painful, stiff joints
  • Usually the small joints of the hands and feet
  • Worse in the morning getting better as the day prgresses

→ This can fluctuate and larger joints can become involved

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7
Q

What is one complication of RA that is life threatening?

A

Subluxation of the atlanto-axial joint

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8
Q

As RA develops, what are some common clinical features?

A
  • Weakening of joint capsules → Joint instability
  • subluxation of joints
  • Deformity
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9
Q

What are some early clinical features of RA?

A
  • Joint effusions

* Wasting of muscles around affected joints

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10
Q

What are 2 deformities of the hand associated with progressive RA?

A
  • Swans neck deformity

* Boutonnier’s deformity

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11
Q

What is felty’s syndrome?

A

RA + Splenomegaly + neutropeniua

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12
Q

What are some pulmonry complications of RA?

A
  • pulmonary fibrosis
  • pleural effusion
  • pulmonary nodules
  • bronchiolitis obliterans
  • complications of drug therapy e.g. methotrexate pneumonitis
  • pleurisy
  • Caplan’s syndrome - massive fibrotic nodules with occupational coal dust exposure
  • infection (possibly atypical) secondary to immunosuppression
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13
Q

What are some extra articular manifestations of RA?

A
  • Nodules → Elbows and Lungs
  • Lymphadenopathy
  • vasculitis
  • Raynaulds syndrome
  • Pericardial Pleural effusions
  • Episcsleritis, scleritis, scleromalacia, Keratoconjunctivitis sicca
  • Osteoporosis
  • amyloidosis
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14
Q

What are the 2 main antibodies that will be raised in RA?

A
  • Rheumatoid factor (RF) → +ve ~70%. ↑↑ titre is associated with severe disease: errosions + extra articular disease
  • Anticyclic Citrullinated Peptide antidodies (Anti-CCP) → Highly specific +ve ~98%
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15
Q

Aside from RF and Anti-CCP, what other tests can be run for RA?

A
  • FBC → often associated with anaemia of chronic disease
  • Inflammation causes ↑ESR, ↑Platlets + ↑CRP
  • X-ray → Loss of joint space, bony errosions, subluxation, carpal destruction.
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16
Q

Which affection of which joints are particularly symptomatic of RA?

A

MCP → metacarpophlangeal joints

PIP → Proximalinterpahlangeal joints

Wrist

MTP → metatarsophalangeal joints

17
Q

What tool is used to calculate disease activity in rheumatoid arthritis?

A
  • DAS28 → Disease activity score

* Aim for less than 3

18
Q

What is the first line treatment for RA?

A
  • DMARDS → Disease Modifying Anti-Rheumatic Drugs

* Methotrexate + Sulfasalazine + Hydroxychloraquin

19
Q

What is a potentially fatal side effect of RA treatment?

A
  • Immunosuppression → esp. Methotrexate

* this can lead to pancytopaenia, ↑ infection susceptability and neutropaenia.

20
Q

What are some common side effects of methotrexate?

A
  • mucositis → Oral ulcers
  • myelosuppression
  • pneumonitis
  • pulmonary fibrosis
  • liver cirrhosis → Hepatotoxicity
21
Q

What does is Methotraxate used for and what is its MOA?

A

• Used to treat: rheumatoid arthritis, psoriasis and
acute lymphoblastic leukaemia.

• Methotrexate is an antimetabolite which inhibits dihydrofolate reductase, an enzyme essential for the synthesis of purines and pyrimidines

22
Q

What are some issues surrounding the prescription of Methotrexate?

A
  • methotrexate is a drug with a high potential for patient harm.
  • methotrexate is taken weekly, rather than daily
  • FBC, U&E and LFTs need to be regularly monitored.
  • ‘FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months’
  • folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose
  • avoid prescribing trimethoprim or cotrimoxazole concurrently - increases risk of marrow aplasia
23
Q

What is the management of RA?

A
  • DMARDS
  • Steroid for falre ups
  • Topical NSAIDs

W224 Rheumatoid arthritis (2 decks)

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