Rheumatoid Arthritis Flashcards
What is the classic age for rheumatoid arthritis?
30s - most people with inflammatory conditions are younger
What is the pattern for inflammatory arthritis?
Peripheral, symmetrical, polyarthritis
What are the differential diagnoses for rheumatoid arthritis?
Psoriatic arthritis
Post-infective arthritis
Lupus, especially if symptoms affecting other systems present
What are the symptoms of mechanical joint pain?
Chronic pain = months-years Slowly worsening Worse with movement Improved by rest Not much swelling Little stiffness = 10-15 mins
What are the symptoms of inflammatory joint pain?
Acute/subacute pain
May worsen quickly
Better after movement
Worse after rest
Swelling often noticeable and may be prominent
Stiffness may be prolonged (hours) and worse in morning
Which joint is usually first to be affected in rheumatoid arthritis?
2nd metacarpo-phalangeal (MCP) joint
Which joints are usually affected in rheumatoid arthritis?
Proximal interphalangeal (PIP) joints of hands MCP joints Joints of wrist Elbow joints Acromioclavicular (AC) joints Cervical spine Hips Knees Metatarsophalangeal (MTP) joints PIP joints of feet
What are the risk factors for rheumatoid arthritis?
Family history
Smoking
What is the role of pregnancy in rheumatoid arthritis?
Pregnancy protective
Post-childbirth causes flare
What are the signs of rheumatoid arthritis?
Affected joints
- Puffy and swollen
- Tender
- Range of movement can be affected
Can larger joints be affected in rheumatoid arthritis?
Yes, they can, but usually later on in disease
Which joints are usually affected in osteoarthritis?
1st carpo-metacarpal (MCP) joints Distal interphalangeal (DIP) joints of hands AC joints Cervical spine Lumbar spine Hips Knees 1st tarso-metatarsal (TMT) joints
What investigations are useful in rheumatoid arthritis?
Ultrasound and MRI useful in early presentation for picking up subclinical synovitis
Also useful in monitoring treatment
Ultrasound used more often than MRI due to access and expense
What is the utility of measuring anti-citrullinated protein antibody (ACPA) and rheumatoid factor?
Very relevant for prognosis
Diagnostic value lower
What are the treatment goals for rheumatoid arthritis?
Reduction of joint inflammation Prevention of joint damage Prevention of long-term associated complications Avoid drug complications Maintenance of quality of life
How and why is remission aimed for in the treatment of rheumatoid arthritis?
Early aggressive treatment > remission ASAP
If you can get patient into remission for 1st 6 months, their prognosis much better, as a lot of erosive damage will occur within this time
What are the pharmacological therapies available for rheumatoid arthritis?
NSAIDs
Disease modifying anti-rheumatic drugs (DMARDs)
Corticosteroids
Analgesics
What is the first line DMARD used?
Methotrexate
What is the efficacy of NSAIDs in the treatment of rheumatoid arthritis?
Good short- and long-term efficacy
What are the biologic DMARDs available?
TNF inhibitors - mainstay of treatment
B cell inhibitor
Cell adhesion inhibitor
IL-6 inhibitor
How does the route of administration of corticosteroids affect their efficacy and side effects?
Oral prednisolone - Efficacious - Side effects - Hypertension - Weight gain - Skin changes - Hyperglycaemia - Osteoporosis Intra-articular steroids - Efficacious in accessible joints - Few side effects if used intermittently
How is disease activity measured in rheumatoid arthritis?
Patient and physician global assessment Swollen and tender joint count O/E Measures of inflammation - CRP - ESR
How is disease damage measured in rheumatoid arthritis?
Bone and cartilage damage slower than soft tissue swelling
MRI more sensitive than x-ray for detecting
- Synovitis
- Cartilage damage
- Bone oedema
- Bone erosions
X-rays usually not needed in early management
