Rheumatoid Arthritis

Question 1

what is rheumatoid arthritis (RA)?

Answer 1

symmetrical inflammatory arthritis affecting peripheral joints

Question 2

what can RA cause?

Answer 2

joint damage

loss of function

Question 3

does RA affect articular or extra-articular surfaces?

Answer 3

both

Question 4

which gender is more likely to get RA?

Answer 4

women

Question 5

prevalence in uk?

Answer 5

1%

Question 6

which is the only area of the spine typically affected and why?

Answer 6

C1 and C2

only part of the spine that contains synovium

Question 7

what comorbidities increase risk of RA?

Answer 7

psoriasis
kidney problems
CV problems
crohns
peripheral nerve problems

Question 8

what is RA in children under 16 called?

Answer 8

juvenile idiopathic arthritis

Question 9

triggers of RA?

Answer 9

smoking
infection
stress

Question 10

what happens to the synovium in RA?

Answer 10

becomes hypertrophic and inflamed

Question 11

what joints does RA affect

Answer 11

synovial joints

Question 12

what other joints are synovium lined?

Answer 12

hand
wrist
elbows
shoulders
TMJs
knees
hips
ankles
feet

Question 13

2 hallmarks of RA

Answer 13

tenosynovitis

synovitis

Question 14

what is a pannus

Answer 14

inflamed spongy synovium

Question 15

what is the pathogenesis of RA

Answer 15

antigen taken up by dendritics -> presented via AP cell to T cells-> inflam cascade

Question 16

what pathogenic effects do osteoclasts have on the joint

Answer 16

erosion of bone

Question 17

what pathogenic substances are produced by B cells?

Answer 17

rheumatoid factor

IL-4

Question 18

what area other than joints is synovium present?

Answer 18

tendon sheath

Question 19

what time frame constitutes early RA?

Answer 19

<2 years since symptom onset

Question 20

what score on the ACR classification does someone need to have definite RA?

Answer 20

6

Question 21

main symptoms of RA?

Answer 21

stiffness (in morning >30 mins)
swelling
pain
SYMMETRICAL

Question 22

methods of diagnosis?

Answer 22

clinical exam
MRI
X ray
US

Question 23

clinical presentation of RA?

Answer 23

PIP/MCP/MTP/wrist synovitis
monoarthritis (will turn into RA)
tenosynovitis
trigger finger
carpal tunnel
polymyalgia
palindronic rheumatism
poor grip
systemic symptoms

Question 24

what is carpal tunnel syndrome in the case of RA?

Answer 24

compression of the median nerve by synovial tissue

Question 25

what 2 autoantibodies are present in RA?

Answer 25

anti CCP

RF

Question 26

which is the more prevalent of the autoantibodies in RA?

Answer 26

RF

Question 27

what’s better US or X rays for RA?

Answer 27

US

Question 28

how many joints can be affected in RA?

Answer 28

32

Question 29

how many joints are recorded on the DAS score?

Answer 29

28

Question 30

what would a DAS score of >5.1 indicate?

Answer 30

active disease

Question 31

what would a DAS score of 3.2-5.1 indicate

Answer 31

moderate disease

Question 32

what would a DAS score of 2.6-3.2 indicate?

Answer 32

low disease activity

Question 33

what would a DAS score of <2.6 indicate?

Answer 33

remission

Question 34

pyramid of treatment for RA?

Answer 34

steroids/NSAIDS until DMARDS kick in
methotrexate
sulfasalazine
hydroxychoroquine
combo therapy (MTX+SASP+HCQ)
leflunomide
gold injections/azathiprine

Question 35

what dose of methotrexate should you start a patient on

Answer 35

15mg/week

Question 36

what should you always give 24 hours after methotrexate dose?

Answer 36

folic acid

Question 37

what lung problem can be caused when taking methotrexate?

Answer 37

pneumonitis

Question 38

when would you consider a biologic agent?

Answer 38

failure to respond to 2 DMARDs and DAS28 >5.1