Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RB Y2 MSK 02 - Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

sero positive or negative

A

seropositive inflammatory arthropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

epidemiology

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

aetiology

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

is there a genetic predisposition

A

yes - HLA-DR4 mediated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what joints in the spine are lined by synovium

A

C1 and C2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what phalangeal joint is not lined by synovium

A

DIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what can happen to the tendons

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what scoring system is used for diagnosis

A

ACR/EULAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is early RA defined as

A

less than 2 years since symptom onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when is the therapeutic window of opportunity

A

first 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

clinical features

A

prolonged morning stiffness that improves with exercise

symmetrical synovitis (doughy swelling)

involvement of small joints of hands and feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is a compression test

A

positive for MCP and MTP

painful if joints are squeezed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is it called when synovitis occusr in tendon sheath

A

tenosynovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is palindromic rheumatism

A

RA that comes and goes, patient is fine between episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

name 2 late features in aggressive/untreated disease

A

swan neck deformity

Boutonniere’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions