Rheumatoid Arthritis Flashcards
What percentage of the general UK population suffer from rheumatoid arthritis?
1%
How can rheumatoid arthritis be defined?
A symmetrical inflammatory arthritis
Which joints (axial/peripheral) does rheumatoid arthritis affect?
Peripheral joints
Rheumatoid arthritis affects only articular joints.
True or false?
False
It affected extra-articular structures e.g. lungs, heart (endocarditis), GI system
Which sex is more likely to suffer from rheumatoid arthritis?
Females (3x more likely)
Rhematoid arthritis is an ___________ condition and is __________ mediated
Autoimmune
HLA-DR4
Give 3 examples of triggers which can bring on rheumatoid arthritis
- Stress
- Infection
- Cigarette smoking
What is the most common form of arthritis in children?
Juvenile idiopathic arthritis
This is essentially rhematoid arthrtis, yet can resolve spontaneously and is not necessarily chronic
The presence of what in rheumatoid arthritis worsens the prognosis?
Auto-antibodies
Which stucture is the main structure involved in rheumatoid arthritis?
Synovium of a synovial joint
(capsules and tendon sheaths may also be affected)
Why can the C1/C2 vertebrae be affected by rheumatoid arthritis when other vertebrae cannot?
They are lined with synovium
Two of the main hallmarks for rheumatoid arthritis are?
- Synovitis
- Tenosynovitis
Tenosynovitis - inflammation of synovium that surrounds a tendon
Regarding rheumatoid arthritis, what does the term “pannus” describe?
The inflamed, spongy synovium as a result of inflammation and hypertrophy
Why does rheumatoid arthritis cause bony erosions?
As part of the inflammatory process, osteoclasts are activated and these break down bone
What are the most frequent joints associated with rheumatoid arthritis?
- Proximal interphalangeal (PIP)
- Metacarpophalangeal (MCP)
How is early rheumatoid arthritis defined?
Rheumatoid arthritis diagnosed less than two years after symptom onset
(the first 3 months offer the best therapeutic window)
Which inflammatory markers can be tested for in rheumatoid arthritis?
- CRP
- ESR
- Plasma viscosity
What is palindromic rhematism?
Rheumatoid arthritis that is episodic
It comes on, completely reverses and comes on again
Which is more specific for rheumatoid arthritis?
- Rheumatoid factor
- Anti-CCP antibodies
Anti-CCP antibodies
(Antibodies to cyclic citrullinated peptide)
These are virtually 100% specific
(but more like 60-70% sensitive)
With treatment, anti-CCP antibodies will reduce as the condition dampens down.
True or false?
False
Anti-CCP antibodies will always be present
What is the gold standard for imaging joints?
MRI
Which scoring system is used for rheumatoid arthritis?
DAS 28
(Disease activity score 28)
(28 joints are tested during the screening test)
Which score on the DAS 28 scoring system indicates severe active disease?
>5.1
Which score on the DAS 28 scoring system indicates remission?
<2.6
Which specific drugs are always given for rheumatoid arthritis?
- Aspirin
- NSAIDS
- DMARDs
What is the first line disease modifying drug for rheumatoid arthritis?
Methotrexate
What is the second line disease modifying drug?
Sulfasalazine
Disease modifying drugs will be given and reassessed ever 6 weeks until what?
Until DAS28 is <2.6
How are steroids used during rheumatoid arthritis?
As a bridge therapy
Then gradually withdrawn
This is due to bad side effects
How often is methotrexate given for patients with rheumatoid arthritis?
Weekly
24 hours after methotrexate administration, what is given?
Folic acid
Which rheumatoid arthritis patients are given disease modifying drugs?
All of them
Which pulmonary condition is associated with the use of methotrexate?
Pneumonitis
(SOB and dry cough too)
The use of biological agents for rheumatoid arthritis may risk reactivation of what condition?
Tb
(the granuloma breaks down as it is partially composed of immune cells)
When are biological agents administered for rheumatoid arthritis?
- There is failure to respond to two DMARDS including methotrexate
- DAS28 >5.1 on two occasions 4 weeks apart
Which drug will be co-prescribed with biological agents for rheumatoid arthritis?
Methotrexate
Rheumatoid arthritis gets worse in pregnancy.
True or false?
False
Rheumatoid arthritis often gets better in pregnancy
