Rheumatoid Arthritis Flashcards
Typical presentation of Rheumatoid Arthritis
Symmetrical, swollen, painful, stiff small joints of hands and feet
How long does morning stiffness last in RA?
> 30 mins
Early signs of RA
Inflammation: swollen MCP, PIP, wrist or MTP joints
Tenosynovitis/bursitis
Later signs of RA
Ulnar deviation of fingers Boutonniere/Swan-neck deformity Z-thumb Subluxation dorsal wrist Loss of knuckle guttering
Extra-articular features of RA (9)
Eyes: Sjögrens, scleritis, episcleritis
Skin: leg ulcers (Felty’s syndrome), rashes, nail fold infarcts
Rheum nodules: eyes, subcut, lung, heart, vocal cords
Neuro: peripheral neuropathy
Resp: pleural effusion, pulm fibr, obliterativ bronchiolitis
Cardio: pericardial effusion, vasculitis
Kidneys: nephropathy
Liver: mild hepatomegaly
Other: Thyroid, osteoborosis, depression
Risk Factors of RA
Female
Age 30-40
Smoking
Genetics: HLA DR4 and HLA DR1
Investigations for RA
Raised inflammatory markers (CRP/ESR)
Rheumatoid factors
Anti-cyclic citrullinated peptide (CCP)
DAS28 to measure disease activity (aim <3)
Criteria for diagnosing RA
Joint involvement <5 pts
Serology (RF or CCP): <3 pts
Abnormal CRP or ESR = 1 pt
Duration of Sx (>6 weeks) = 1 pt
RA Tx to induce remission
Glucocorticoid steroids (Prednisolone)
RA Tx to maintain remission
DMARDs (Methotrexate and at least one other DMARD)
RA Tx for symptomatic relief
NSAIDs with PPI (omeprazole)
When do you start Biologics to treat RA?
Failure to respond to 2 DMARDs and DAS28>5.1
What is the 1st line Biologic for treatment of RA?
TNFa inhibitors (Infliximab, etanercept, adalimumab, certolizumabpegol and golimumab)
What is used to measure disease activity of RA?
DSA28 (28 joint disease activity score). Assesses tenderness and swelling, ESR and patients self reported symptoms severity. Aim for <3
Xray findings of rheumatoid arthritis
Loss of joint space
Joint deformity
Juxta-articular osteopenia
Soft tissue swelling
