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The Musculoskeletal System > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What percentage of the general UK population suffer from rheumatoid arthritis?

A

1%

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2
Q

How can rheumatoid arthritis be defined?

A

A symmetrical inflammatory arthritis

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3
Q

Which joints (axial/peripheral) does rheumatoid arthritis affect?

A

Peripheral joints

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4
Q

Rheumatoid arthritis affects only articular joints.

True or false?

A

False

It affected extra-articular structures e.g. lungs, heart (endocarditis), GI system

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5
Q

Which sex is more likely to suffer from rheumatoid arthritis?

A

Females (3x more likely)

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6
Q

Rhematoid arthritis is an ___________ condition and is __________ mediated

A

Autoimmune

HLA-DR4

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7
Q

Give 3 examples of triggers which can bring on rheumatoid arthritis

A
  1. Stress
  2. Infection
  3. Cigarette smoking
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8
Q

What is the most common form of arthritis in children?

A

Juvenile idiopathic arthritis

This is essentially rhematoid arthrtis, yet can resolve spontaneously and is not necessarily chronic

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9
Q

The presence of what in rheumatoid arthritis worsens the prognosis?

A

Auto-antibodies

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10
Q

Which stucture is the main structure involved in rheumatoid arthritis?

A

Synovium of a synovial joint

(capsules and tendon sheaths may also be affected)

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11
Q

Why can the C1/C2 vertebrae be affected by rheumatoid arthritis when other vertebrae cannot?

A

They are lined with synovium

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12
Q

Two of the main hallmarks for rheumatoid arthritis are?

A
  1. Synovitis
  2. Tenosynovitis

Tenosynovitis - inflammation of synovium that surrounds a tendon

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13
Q

Regarding rheumatoid arthritis, what does the term “pannus” describe?

A

The inflamed, spongy synovium as a result of inflammation and hypertrophy

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14
Q

Why does rheumatoid arthritis cause bony erosions?

A

As part of the inflammatory process, osteoclasts are activated and these break down bone

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15
Q

What are the most frequent joints associated with rheumatoid arthritis?

A
  • Proximal interphalangeal (PIP)
  • Metacarpophalangeal (MCP)
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16
Q

How is early rheumatoid arthritis defined?

A

Rheumatoid arthritis diagnosed less than two years after symptom onset

(the first 3 months offer the best therapeutic window)

17
Q

Which inflammatory markers can be tested for in rheumatoid arthritis?

A
  • CRP
  • ESR
  • Plasma viscosity
18
Q

What is palindromic rhematism?

A

Rheumatoid arthritis that is episodic

It comes on, completely reverses and comes on again

19
Q

Which is more specific for rheumatoid arthritis?

  1. Rheumatoid factor
  2. Anti-CCP antibodies
A

Anti-CCP antibodies

(Antibodies to cyclic citrullinated peptide)

These are virtually 100% specific

(but more like 60-70% sensitive)

20
Q

With treatment, anti-CCP antibodies will reduce as the condition dampens down.

True or false?

A

False

Anti-CCP antibodies will always be present

21
Q

What is the gold standard for imaging joints?

A

MRI

22
Q

Which scoring system is used for rheumatoid arthritis?

A

DAS 28

(Disease activity score 28)

(28 joints are tested during the screening test)

23
Q

Which score on the DAS 28 scoring system indicates severe active disease?

A

>5.1

24
Q

Which score on the DAS 28 scoring system indicates remission?

A

<2.6

25
Q

Which specific drugs are always given for rheumatoid arthritis?

A
  • Aspirin
  • NSAIDS
  • DMARDs
26
Q

What is the first line disease modifying drug for rheumatoid arthritis?

A

Methotrexate

27
Q

What is the second line disease modifying drug?

A

Sulfasalazine

28
Q

Disease modifying drugs will be given and reassessed ever 6 weeks until what?

A

Until DAS28 is <2.6

29
Q

How are steroids used during rheumatoid arthritis?

A

As a bridge therapy

Then gradually withdrawn

This is due to bad side effects

30
Q

How often is methotrexate given for patients with rheumatoid arthritis?

A

Weekly

31
Q

24 hours after methotrexate administration, what is given?

A

Folic acid

32
Q

Which rheumatoid arthritis patients are given disease modifying drugs?

A

All of them

33
Q

Which pulmonary condition is associated with the use of methotrexate?

A

Pneumonitis

(SOB and dry cough too)

34
Q

The use of biological agents for rheumatoid arthritis may risk reactivation of what condition?

A

Tb

(the granuloma breaks down as it is partially composed of immune cells)

35
Q

When are biological agents administered for rheumatoid arthritis?

A
  1. There is failure to respond to two DMARDS including methotrexate
  2. DAS28 >5.1 on two occasions 4 weeks apart
36
Q

Which drug will be co-prescribed with biological agents for rheumatoid arthritis?

A

Methotrexate

37
Q

Rheumatoid arthritis gets worse in pregnancy.

True or false?

A

False

Rheumatoid arthritis often gets better in pregnancy

The Musculoskeletal System (58 decks)

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