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MSK week 2 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is early rheumatoid

A

Rheumatoid 2 years from symptom onset

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2
Q

What is the definition of rheumatoid arthritis

A

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

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3
Q

women are affected _ times as commonly as men

A

3

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4
Q

What is the autoimmune mediated by?

A

HLA-DR4

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5
Q

There is no link between smoking and RA T/F

A

F- there is a link, cigarette smoking are seen as potential triggers

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6
Q

What structures does the synovial line

A

The synovial joint capsule and tendon sheath

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7
Q

Which two joints in the spine are synovial lined

A

C1/C2

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8
Q

DIP joints are not involved in RA T/F

A

T- there is not enough synovial

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9
Q

Synovitis is the hallmark of RA T/F

A

TRUE- very inflamed

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10
Q

What does an osteoclast do?

A

Dissolve bone

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11
Q

What inflammatory cytokines are being produced by the macrophages?

A

TNFa
IL-1
IL-2

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12
Q

What cell produces the rheumatoid factor?

A

B-cell

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13
Q

What is the ACR/EULAR classification criteria for RA

A 
Joint distribution (0-5)
Serology (0-3)
Symptom duration (0-1)
Acute phase reactants (0-1)
If over 6 then definite RA
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14
Q

How is it diagnosed?

A

History and clinical examination
Routine blood testing-anaemia or chronic disease ,raised platlets
Inflammatory markers (CRP,ESR,Plasma viscosity)
Autoantibodies
Imaging

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15
Q

What are clinical features?

A

Prolonged moring stiffness
involvement of small joints of hands and feet
Symmetric distribution
Positive compression tests or MCP and MTP joints

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16
Q

Clinical presentation

A 
PIP,MCP,wrist,MTP synovitis
Monoarthiritis
Tenosynovitis
Trigger finger
Carpal tunnel syndrome
Polymyalgia rheumatica
Palindromic rheumatism
Systemic symptoms
Poor grip strength
17
Q

What is carpal tunnel syndrome?

A

compression of the medial nerve

18
Q

What is palindromic rheumatism

A

rare episodic form of inflammatory arthritis – meaning the joint pain and swelling come and go.

19
Q

What are the two autoantibody that can be testing in clinical practise?

A 
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

20
Q

What are anti CCP most likely to be associated with

A

Erosive damage

21
Q

What 3 imaging techniques could be used?

A

Plain X-rays of hands and feet
Ultrasound scanning
MRI scans

22
Q

Plain X-rays are especially good at visualising

A

Soft tissue swelling
Periarticular osteopanenia
Erosions

however absence of findings in early disease

23
Q

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

A

7

24
Q

Whats is the DAS 28 score

A

Disease activity score calculator for rheumatoid arthritis. 28 because there are 28 joints

25
Q

What score of DAS represents remission

A

2.6

26
Q

Which scan can distinguish synovitis from effusions?

A

MRI scan

27
Q

What is the DAS28 scoring for active disease?

A

over 5.1

28
Q

What is the management for RA

A

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

29
Q

Steroids for RA?

A

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

30
Q

Name the most popular DMARDs?

A

Methotrexate
sulfasalazine
Hydroxychloroquine- does not prevent erosions

31
Q

How often is methotrexate taken and what must it be taken with

A

Weekly drug(max 25mg)

Folic acid must be given with it because it affects folic acid absorption by bones

32
Q

What can methotrexate do to the lungs?

A

Pneumonitis

33
Q

What combination therapy should be used?

A

MTX(methotrexate) and SASP(sulfasalazine) and HCQ(Hydroxychloroquine)

Imprortant to discuss contraception

34
Q

What are the negatives of DMARDs

A 
Regular monitoring needed
Bone marrow suppression
Infection
Liver function derangement
Pneumonitis in case of methotrexate
35
Q

When do you prescribe biological agents?

A

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

36
Q

Steroids should only be used as bridging therapy and for flares only T/F

A

T

MSK week 2 (11 decks)

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