Rheumatoid Arthritis

Question 1

What is rheumatoid arthritis?

Answer 1

A symmetrical inflammatory arthritis affecting mainly the peripheral joints

Question 2

Does rheumatoid arthritis only affect joints?

Answer 2

No - it can cause inflammation in organs and nerves

Question 3

Which spinal levels are affected by rheumatoid arthritis?

Answer 3

C1

C2

Question 4

What cell mediates rheumatoid arthritis?

Answer 4

HLA-DR4

Question 5

Cigarette smoking has a proven link to rheumatoid arthritis. True/false?

Answer 5

True

Question 6

What is the main structure involved in rheumatoid arthritis?

Answer 6

Synovium

Question 7

In rheumatoid arthritis, what happens to the synovial membrane?

Answer 7

Becomes hypertrophic and inflamed

Question 8

Is the synovium involved in osteoarthritis?

Answer 8

No

Question 9

Outline the pathogenesis of rheumatoid arthritis

Answer 9

APC presents antigen to naive T cell activating it
Activated T cell activates macrophages to release cytokines (TNF-alpha, IL-1, IL-6) that cause destruction of chondrocytes
Activated T cell also activates B cells which release antibodies

Question 10

The earlier rheumatoid is treated the better the prognosis. True/false?

Answer 10

True

Question 11

What is considered when diagnosing rheumatoid arthritis?

Answer 11

Joint distribution
CRP
ESR
Serology
Symptom duration

Question 12

How is rheumatoid arthritis diagnosed?

Answer 12

History 
Blood testing
Inflammatory markers
Autoantibodies
Imaging

Question 13

Give some clinical features of rheumatoid arthritis

Answer 13

Prolonged morning stiffness
Involvement of small joints in hands and feet
Symmetric distribution
+ve compression tests of MCP and MTP joints

Question 14

What autoantibodies are measured in diagnosing rheumatoid arthritis?

Answer 14

Rheumatoid factor

Anti-CCP

Question 15

Which autoantibody is more commonly used? Why?

Answer 15

Anti-CCP - has a specificity of ~100%

Question 16

What imaging can be used in rheumatoid arthritis?

Answer 16

Plain x-rays
Ultrasound scanning
MRI scans

Question 17

X-rays are useful as they can be used to diagnose rheumatoid arthritis early. True/false?

Answer 17

False - X-rays are useful once the disease has progressed

Question 18

Ultrasound can detect far more MCP erosions than x-ray in early rheumatoid arthritis. True/false?

Answer 18

True

Question 19

Which imaging technique is the gold standard in rheumatoid arthritis?

Answer 19

MRI scans

Question 20

What scoring system is used in assessment of rheumatoid arthritis activity?

Answer 20

DAS28

Question 21

Outline the figures of the DAS28 scoring

Answer 21

> 5.1 - active disease
3.2-5.1 - moderate disease
2.6-3.2 - low disease activity
<2.6 - remission

Question 22

What is the current treatment for rheumatoid arthritis?

Answer 22

Aspirin/NSAIDs
+ steroids
+ DMARD (up to 3)

Question 23

What is a DMARD?

Answer 23

A disease modifying anti-rheumatic drug that limits B cells and T cells and reduces cell proliferation

Question 24

Give some examples of DMARDs

Answer 24

Methotrexate
Sulfasalazine
Hydroxychloroquine

Question 25

Are steroids given in rheumatoid arthritis?

Answer 25

Yes - in combination with DMARDS

Question 26

What is the respiratory side effect of methotrexate?

Answer 26

Pnuemonitis

Question 27

What should be monitored with patients on DMARDs?

Answer 27

LFTs
Bone marrow suppressement
Contraception - have teratgenic effects

Question 28

What class of drug can be used in place of DMARDs to treat rheumatoid arthritis?

Answer 28

Biological agenta

Question 29

When are biologic agents used?

Answer 29

When the patient has not responded to 2 DMARDs and DAS28 > 5.1 on 2 occasions 4 weeks apart

Question 30

Give some complications of untreated rheumatoid arthritis

Answer 30

Joint damage
Swan necking
Boutonniere’s
Atlanto-axial subluxation