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MSK- Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What type of arthritis is rheumatoid?

A

Symmetrical inflammatory seropositive

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2
Q

Which group of joints does RA mostly affect?

A

Peripheral

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3
Q

Are the deformities of RA reversible?

A

No

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4
Q

Can RA affect extra-articular structures?

A

Yes

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5
Q

What is the sex distribution of RA?

A

3 times more common in women than men

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6
Q

What age group can RA affect? What is the age range of peak prevalence?

A

Can affect any age group

Highest prevalence 35-50

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7
Q

What is RA known as when it occurs in under 16s?

A

Juvenile idiopathic arthritis

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8
Q

RA is what type of disease?

A

Autoimmune

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9
Q

What mediates RA in a genetically susceptible individual?

A

HLA-DR4

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10
Q

Genetic factors are responsible for what percentage of the risk of developing RA?

A

50%

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11
Q

First degree relatives of a person with RA are how many times more likely to develop the condition themselves?

A

2-3 times

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12
Q

What are some potential triggers of RA?

A

Infections, stress and smoking

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13
Q

The presence of autoantibodies has what effect on the prognosis?

A

Worse prognosis

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14
Q

What is the main structure involved in RA? Where is this found?

A

Synovium- inside synovial joint capsules and tendon sheaths

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15
Q

Which joints can RA affect?

A

Only those which contain synovium

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16
Q

Which joints in the spine can RA affect? Why is this? What can happen if these joints are badly affected?

A

C1 and C2- they are the only ones containing synovium

They can subluxate and cause spinal cord compression

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17
Q

What happens to the synovial membrane in RA?

A

Becomes very hypertrophic and inflamed

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18
Q

What gets released which leads to joint destruction?

A

Inflammatory cytokines

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19
Q

What can damage to the tendons and soft tissues cause?

A

Subluxation and joint instability

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20
Q

What do B cells in RA release?

A

Rheumatoid factor and IL-6

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21
Q

What do T cells in RA release?

A

TNF alpha, IL-1 and IL-6

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22
Q

Erosions on imaging are a result of what?

A

Osteoclast activity

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23
Q

Which joints in the hand are spared in RA? Why is this?

A

DIP joints due to a lack of synovium

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24
Q

What defines early rheumatoid arthritis?

A

Less than 2 years since symptom onset

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25
Q

What is the therapeutic window of better outcomes in RA?

A

First 3 months

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26
Q

Morning stiffness in RA should last how long?

A

> 30 mins

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27
Q

RA usually affects how many joint areas?

A

3 or more

28
Q

What is the most common place to get RA?

A

Hands

29
Q

What is a less common feature that occurs in around 25% of patients? Where are these most likely to occur?

A

Rheumatoid nodules- on the extensor surfaces or sites of frequent mechanical irradiation

30
Q

What are three different types of lung involvement?

A

Pleural effusions, interstitial fibrosis or pulmonary nodules

31
Q

Morbidity and mortality due to what is increased in RA?

A

Cardiovascular disease

32
Q

What are some examples of ocular involvement?

A

Keratoconjunctivitis sicca, episcleritis, uveitis, nodular scleritis

33
Q

What is the end point of ocular involvement in RA?

A

Scleromalacia

34
Q

Routine blood tests should be taken to look for what?

A

Anaemia, raised platelets and inflammatory markers

35
Q

What 3 imaging types can be used for RA diagnosis?

A

X-ray, US, MRI

36
Q

Which imaging test can be useful for detecting synovial inflammation to confirm a diagnosis?

A

US

37
Q

What may be some early signs of RA on x-ray?

A

Peri-articular osteopenia, soft tissue swelling

38
Q

What is a late sign of RA on x-ray?

A

Erosions and deformities

39
Q

Compression of which joints will be extremely painful in RA?

A

MTP and MCP

40
Q

What is the best antibody test for RA? What other antibody may show up?

A

Anti-CCP- best

Rheumatoid factor- may also show

41
Q

What type of antibody is rheumatoid factor?

A

IgM

42
Q

Rheumatoid factor can also come up positive in patients with what else?

A

Infections or cancer

43
Q

Can a patient still have RA without antibodies?

A

Yes

44
Q

What imaging should always be done in a possible case of RA, even if there are no symptoms there?

A

X-ray of hands and feet

45
Q

What, when seen on MRI is associated with inflammatory joint disease and may be a forerunner of erosions?

A

Bone marrow oedema

46
Q

What test is gold standard for joint disease?

A

MRI

47
Q

What gets missed out of DAS28 scoring?

A

Feet and ankles

48
Q

What DAS28 score indicates active disease?

A

> 5.1

49
Q

What DAS28 score indicates moderate disease?

A

3.2-5.1

50
Q

What DAS28 score indicates low disease activity?

A

2.6-3.2

51
Q

What DAS28 score indicates remission?

A

< 2.6

52
Q

What medications can be used as adjuncts in RA therapy?

A

Simple analgesia, NSAIDs and steroids

53
Q

Can you take patients off drugs in RA?

A

Yes, if they improve

54
Q

When should steroids be used in RA?

A

In combination with DMARDs

55
Q

How can steroids be given?

A

Oral, IM, IA

56
Q

How should patients be taken off steroids?

A

Gradually

57
Q

What is the first line DMARD drug?

A

Methotrexate

58
Q

What are some other DMARD drugs?

A

Sulphasalazine, hydroxychloroquine, leflunomide

59
Q

What does hydroxychloroquine not do which other DMARDs do?

A

Prevent erosions

60
Q

Why should you always give steroids and DMARDs?

A

Because DMARDs take a while to work so steroids calm inflammation in the meantime

61
Q

What adverse effect can DMARDs cause? How can this be monitored?

A

Bone marrow suppression- monitor with regular blood tests

62
Q

What lung problem can methotrexate cause? What should patients be told about this when they begin therapy?

A

Pneumonitis- report any dyspnoea or dry coughs

63
Q

Can you get pregnant on DMARDs? What do you need to tell patients?

A

No, they are teratogenic (except sulphasalazine)- tell patients about contraception

64
Q

When can biologics be used for RA?

A

If there has been failure to respond to at least two DMARDs (including methotrexate) and the DAS28 score > 5.1

65
Q

Which biologic agents are best for RA? Give examples.

A

Anti-TNF e.g. infliximab, adalimumab

66
Q

What is the risk of biologics?

A

Immunosuppression and severe infection

67
Q

What should all patients be screened for before starting biologics?

A

TB

MSK- Rheumatology (12 decks)

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