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RB Y2 MSK 02 - Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

sero positive or negative

A

seropositive inflammatory arthropathy

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2
Q

define RA

A

symmetrical inflammatory arthritis affecting mainly the peripheral joints, which if untreated can lead to joint damage and irreversible deformities leading to loss of function

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3
Q

epidemiology

A

women>men. can occur in any age group. the prevalence is increased in smokers

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4
Q

aetiology

A

cause is unknown, potential triggers include smoking, infections and stress

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5
Q

is there a genetic predisposition

A

yes - HLA-DR4 mediated

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6
Q

pathology

A

immune response is initiated against the synovium which lines the synovial joints and some tendons.

inflammatory pannus forms and then attacks and denudes cartilage leading to joint destruction.

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7
Q

what joints in the spine are lined by synovium

A

C1 and C2

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8
Q

what phalangeal joint is not lined by synovium

A

DIP

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9
Q

what can happen to the tendons

A

can rupture and soft tissue damage can occur - joint instability and subluxation

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10
Q

what scoring system is used for diagnosis

A

ACR/EULAR

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11
Q

what is early RA defined as

A

less than 2 years since symptom onset

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12
Q

when is the therapeutic window of opportunity

A

first 3 months

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13
Q

clinical features

A

prolonged morning stiffness that improves with exercise

symmetrical synovitis (doughy swelling)

involvement of small joints of hands and feet

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14
Q

what is a compression test

A

positive for MCP and MTP

painful if joints are squeezed

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15
Q

what is it called when synovitis occusr in tendon sheath

A

tenosynovitis

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16
Q

name some more features of RA

A

tenosynovitis

trigger finger

carpal tunnel syndrome (compression of medial nerve by synovial tissue bilaterally)

polymyalgia rheumatica

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17
Q

what is palindromic rheumatism

A

RA that comes and goes, patient is fine between episodes

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18
Q

name 2 late features in aggressive/untreated disease

A

swan neck deformity

Boutonniere’s

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19
Q

describe the nodules that can be found as an extra articular manifestation

A

rheumatoid nodules found on extensor surfaces or areas of frequent mechanical irritation

20
Q

describe other organ features

A

lung - pleural effusions, interstitial fibrosis or pulmonary nodules

CVS morbidity and mortality increased

occular involvement

21
Q

Caplan’s syndrome

A

rheumatoid arthritis and pneumoconiosis

combination of inhaled dust and disturbed immunity of RA that manifests as intrapulmonary nodules

occurs particularly in coal worker’s pneumoconiosis

22
Q

auto antibodies

A

rheumatoid factor

anti-CCP

23
Q

anti-CCP antibodies after treatment and associations

A

can remain positive despite treatment, also associated with current or previous smoking

24
Q

inflammatory markers

A

CRP, ESR and PV normally raised

25
Q

imaging options

A

x ray

US

MRI

26
Q

x ray

A

at onset of disease will show no joint abnormality

can sow peri articular osteopaenia (bone thinning), soft tissue swelling, joint space narrowing and erosions later in disease

27
Q

US

A

useful in detecting synovial inflammation if there is uncertainty

useful for making treatment changes

28
Q

MRI

A

bone marrow oedema can precede erosion in inflammatory joint disease

can distinguis synovitis from effusions

detect erosions early

monitor disease activity

but expensive

29
Q

what are the aims of treatment

A

relieving symptoms and preventing disease progression

30
Q

when should DMARD therapy be commenced

A

within 3 months of symptom onset

steroids can be used in the time that DMARDs take to have effect

31
Q

what scoring system is used to determine whether patients qualify for therapy

A

DAS 28 score

composite score of tender and swollen joint count, CRP/ESR and visual analogue score

32
Q

what DAS 28 score suggests remission

A

<2.6

33
Q

what DAS 28 score suggests active disease

A

>5.1

  1. 2-5.1 moderate
  2. 6-3.2 low
34
Q

outline treatment

A

DMARDs given - methotrexate is first line

steroids, NSAIDs, analgesia given while DMARD is taking time to work

if DMARD doesnt work (patient has tried 2 different types) patient may qualify for biologic therapy

35
Q

what does DMARD therapy include

A

methotrexate is first line

also sulphasalazine, hydroxychloroquine, leflunomide

36
Q

what side effects can DMARDs have

A

mostly IS

can inc risk of infection and cause bone marrow suppression

regular blood monitoring is therefore required

37
Q

what effect on pregnancy do DMARDs have

A

methotrexate is teratogenic - must be stopped 3 months before conceiving, and appropriate contraception advised. has no effect on fertility however

sulphasalazine can be used throughout pregnancy

38
Q

if patient doesnt respond to DMARD therapy

A

biological therapy - anti - TNF alpha drugs

39
Q

what can untreated RA lead to

A

joint damage and deformities: swan necking and Boutonniere’s

atlanto-axaial subluxation resulting in cervical cord compression

40
Q

trigger finger

A

tendon becomes swollen and inflamed and catches in the tendon sheath - difficult to move and clicking sensation

41
Q

what is the first line DMARD

A

methotrexate

sulphasalazine is added on

42
Q

how is patient disease monitored

A

DAS 28 score

43
Q

what must be taken with methotrexate

A

folic acid

44
Q

adverse effects of methotrexate

A

pneumonitis

teratogenic

alcohol intake must be limited as methotrexate also affects the liver

rash/mouth ulcers

45
Q

what qualifies patients for biologic therapy

A

disease doesnt respond to DMARD therapy - 2 drugs tried

DAS 28 score > 5.1

46
Q

what are the adverse affects of biologic drugs

A

reactivate latent TB

inc risk of skin cancer

inc risk of infection

RB Y2 MSK 02 - Rheumatology (33 decks)

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