Rheumatoid Arthritis Flashcards
what is rheumatoid arthritis (RA)?
symmetrical inflammatory arthritis affecting peripheral joints
what can RA cause?
joint damage
loss of function
does RA affect articular or extra-articular surfaces?
both
which gender is more likely to get RA?
women
prevalence in uk?
1%
which is the only area of the spine typically affected and why?
C1 and C2
only part of the spine that contains synovium
what comorbidities increase risk of RA?
psoriasis kidney problems CV problems crohns peripheral nerve problems
what is RA in children under 16 called?
juvenile idiopathic arthritis
triggers of RA?
smoking
infection
stress
what happens to the synovium in RA?
becomes hypertrophic and inflamed
what joints does RA affect
synovial joints
what other joints are synovium lined?
hand wrist elbows shoulders TMJs knees hips ankles feet
2 hallmarks of RA
tenosynovitis
synovitis
what is a pannus
inflamed spongy synovium
what is the pathogenesis of RA
antigen taken up by dendritics -> presented via AP cell to T cells-> inflam cascade
what pathogenic effects do osteoclasts have on the joint
erosion of bone
what pathogenic substances are produced by B cells?
rheumatoid factor
IL-4
what area other than joints is synovium present?
tendon sheath
what time frame constitutes early RA?
<2 years since symptom onset
what score on the ACR classification does someone need to have definite RA?
6
main symptoms of RA?
stiffness (in morning >30 mins)
swelling
pain
SYMMETRICAL
methods of diagnosis?
clinical exam
MRI
X ray
US
clinical presentation of RA?
PIP/MCP/MTP/wrist synovitis monoarthritis (will turn into RA) tenosynovitis trigger finger carpal tunnel polymyalgia palindronic rheumatism poor grip systemic symptoms
what is carpal tunnel syndrome in the case of RA?
compression of the median nerve by synovial tissue
what 2 autoantibodies are present in RA?
anti CCP
RF
which is the more prevalent of the autoantibodies in RA?
RF
what’s better US or X rays for RA?
US
how many joints can be affected in RA?
32
how many joints are recorded on the DAS score?
28
what would a DAS score of >5.1 indicate?
active disease
what would a DAS score of 3.2-5.1 indicate
moderate disease
what would a DAS score of 2.6-3.2 indicate?
low disease activity
what would a DAS score of <2.6 indicate?
remission
pyramid of treatment for RA?
steroids/NSAIDS until DMARDS kick in methotrexate sulfasalazine hydroxychoroquine combo therapy (MTX+SASP+HCQ) leflunomide gold injections/azathiprine
what dose of methotrexate should you start a patient on
15mg/week
what should you always give 24 hours after methotrexate dose?
folic acid
what lung problem can be caused when taking methotrexate?
pneumonitis
when would you consider a biologic agent?
failure to respond to 2 DMARDs and DAS28 >5.1
