Rheumatoid Arthritis Flashcards
What is early rheumatoid
Rheumatoid 2 years from symptom onset
What is the definition of rheumatoid arthritis
Symmetrical inflammatory arthritis affecting mainly the peripheral joints which is untreated can lead to joint damage and irreversible deformities leading to a loss of function and increased morbidity and mortality
women are affected _ times as commonly as men
3
What is the autoimmune mediated by?
HLA-DR4
There is no link between smoking and RA T/F
F- there is a link, cigarette smoking are seen as potential triggers
What structures does the synovial line
The synovial joint capsule and tendon sheath
Which two joints in the spine are synovial lined
C1/C2
DIP joints are not involved in RA T/F
T- there is not enough synovial
Synovitis is the hallmark of RA T/F
TRUE- very inflamed
What does an osteoclast do?
Dissolve bone
What inflammatory cytokines are being produced by the macrophages?
TNFa
IL-1
IL-2
What cell produces the rheumatoid factor?
B-cell
What is the ACR/EULAR classification criteria for RA
Joint distribution (0-5) Serology (0-3) Symptom duration (0-1) Acute phase reactants (0-1) If over 6 then definite RA
How is it diagnosed?
History and clinical examination
Routine blood testing-anaemia or chronic disease ,raised platlets
Inflammatory markers (CRP,ESR,Plasma viscosity)
Autoantibodies
Imaging
What are clinical features?
Prolonged moring stiffness
involvement of small joints of hands and feet
Symmetric distribution
Positive compression tests or MCP and MTP joints
Clinical presentation
PIP,MCP,wrist,MTP synovitis Monoarthiritis Tenosynovitis Trigger finger Carpal tunnel syndrome Polymyalgia rheumatica Palindromic rheumatism Systemic symptoms Poor grip strength
What is carpal tunnel syndrome?
compression of the medial nerve
What is palindromic rheumatism
rare episodic form of inflammatory arthritis – meaning the joint pain and swelling come and go.
What are the two autoantibody that can be testing in clinical practise?
Rheumatoid factor ( Rheumatoid IgM)- around 75% sepecific Autoantibodies to cyclic cirullinated peptide (Anti-CCP antibodies)-around 95% specific
Should not base diagnosis on absence of these as they are only around 70% sensitive
What are anti CCP most likely to be associated with
Erosive damage
What 3 imaging techniques could be used?
Plain X-rays of hands and feet
Ultrasound scanning
MRI scans
Plain X-rays are especially good at visualising
Soft tissue swelling
Periarticular osteopanenia
Erosions
however absence of findings in early disease
Ultrasound scans can detect up to _ times more MCP erosions than plain x-rays in early RA. IT ALSO HAS INCREASED SENSITIVITY FOR SYNOVITIS in early disease
7
Whats is the DAS 28 score
Disease activity score calculator for rheumatoid arthritis. 28 because there are 28 joints
What score of DAS represents remission
2.6
Which scan can distinguish synovitis from effusions?
MRI scan
What is the DAS28 scoring for active disease?
over 5.1
What is the management for RA
Early rec and diagnosis and care by rheumatologist
Early treatment with disease modifying anti-rheumatic drugs for all patients with RA
Use of NSAIDs e.g. aspirin and steroids only as adjuncts
Patient education and MDT involvement
Steroids for RA?
Shown to reduce symptoms and reduce damage
Used in combination with DMARDs-NOT to be used as a sole therapy
Can be given orally, IA,IM
If fewer than 5 joints involved - IA injections
Name the most popular DMARDs?
Methotrexate
sulfasalazine
Hydroxychloroquine- does not prevent erosions
How often is methotrexate taken and what must it be taken with
Weekly drug(max 25mg)
Folic acid must be given with it because it affects folic acid absorption by bones
What can methotrexate do to the lungs?
Pneumonitis
What combination therapy should be used?
MTX(methotrexate) and SASP(sulfasalazine) and HCQ(Hydroxychloroquine)
Imprortant to discuss contraception
What are the negatives of DMARDs
Regular monitoring needed Bone marrow suppression Infection Liver function derangement Pneumonitis in case of methotrexate
When do you prescribe biological agents?
Failure to respond to 2 DMARDs including methotrexate and DAS 28 STILL GREATER THAN 5.1 ON TWO SEPARATE OCCASIONS 4 WEEKS APART
Methotrexate therapy is co-prescribed
Steroids should only be used as bridging therapy and for flares only T/F
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