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Y2 MSK > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Female to male ratio for rheumatoid arthritis

A

3:1

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2
Q

Dose of sulfasalazine

A

40mg/kg/day

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3
Q

Presentation of rheumatoid arthritis?

A

symmetrical distribution, positive compression test of the MCP and MTP joints, involvement of the small joints of the hands and feet, tenosynovitis, carpal tunnel syndrome

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4
Q

A DAS-28 score of <2.6 indicates?

A

disease remission

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5
Q

What must patients be screened for before commencing biologic therapy? (5)

A

TB, Hep B/C, HIV, varicella zoster

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6
Q

A DAS-28 score of 2.6-3.2 indicates?

A

low disease activity

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7
Q

Which vertebrae may be affected by rheumatoid arthritis?

A

C1/2

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8
Q

1st line treatment for rheumatoid arthritis

A

DMARDS

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9
Q

Rheumatoid Arthritis

A

symmetrical inflammatory arthritis mainly affecting the peripheral joints

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10
Q

When should steroids be used in rheumatoid arthritis?

A

To start treatment until DMARDs kick in and to control flare ups

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11
Q

X-ray findings in more advanced rheumatoid arthritis?

A

erosions, soft tissue swelling, periarticular osteopaenia

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12
Q

Use of USS in rheumatoid arthritis?

A

good for detecting synovitis and 7x more MCP erosions than an x-ray

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13
Q

Side effect of methotrexate

A

may cause bone marrow suppression

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14
Q

Describe a swan neck deformity

A
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15
Q

Key clinical features pointing to an inflammatory rheumatoid disease

A

prolonged morning stiffness, fatigue, weight loss, fever

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16
Q

Describe a boutonniere deformity

A
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17
Q

A DAS-28 score of >5.1 indicates?

A

severe, active disease

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18
Q

A DAS-28 score of 3.2-5.1 indicates?

A

moderate disease activity

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19
Q

Complications of unresolved rheumatoid arthritis

A

Swan-neck deformities and boutonnieres, atlanto-axial subluxation

20
Q

Example B cell depletor

21
Q

Dose of methotrexate used initially in Rheumatoid arthritis?

22
Q

What must be prescribed with methotrexate and why?

A

folic acid - MTX prevents the incorporation of folic acid into the joint

23
Q

How are DMARDs typically prescribed?

A

as a combination therapy i.e. MTX, Sulfasalazien and hydroxychloroquine

24
Q

Which auto-antibody test is more specific to rheumatoid arthritis?

25
X-rays in early rheumatoid arthritis may show?
nothing or some soft tissue swelling
26
why is hydroxychloroquine prescribed alongside methotrexate?
it does not prevent erosions
27
Ideal timescale for starting rheumatoid arthritis treatment?
3 months from symptom onset
28
How is methotrexate best taken?
parenterally to provide best bioavailability i.e. IM, IV
29
3rd line DMARD
hydroxychloroquine
30
Example anti-TNF agent
infliximab, etanercept
31
What needs to be monitored in DMARD therapy?
LFTs and FBCs, chest x-ray for MTX related pneumonitis
32
2nd line DMARD
sulfasalazine
33
Particularly which joints tend to be involved in early Rheumatoid arthritis?
PIP, MCP, wrist, MTP - synovitis
34
Which joints may be affected by rheumatoid arthritis?
hands/wrists/elbow/shoulders, TMJ, feet/ankles/knee/hip, C1/2
35
What must men and women be made aware of before starting DMARD therapy?
teratogenicity - must be on contraception and not use drugs 3 months prior to trying to conceive
36
Gold standard test in Rheumatoid arthritis and why is it not performed more often?
MRI - costly and takes a lot of time. Has the ability to show bone marrow oedema before soft tissue disease and can differentiate between synovitis and effusions
37
Autoantibody tests in rheumatoid arthritis
Rheumatoid factor, Anti-CCP
38
What is the pathophysiology behind the inflammation in rheumatoid arthritis?
inflammation recruits cytokines and osteoclasts to cause joint effusion and destruction of bone
39
1st line DMARD
methotrexate
40
Genetics associated with rheumatoid arthritis
HLA DR4
41
Main structure attacked in rheumatoid arthritis?
the synovium lining the synovial joints
42
More advanced rheumatoid arthritis may present with...
swan-neck deformities, z-deformity of the thumb, ulnar deviation of the fingers
43
What is the DAS-28 score?
the disease activity score used for monitoring rheumatoid arthritis
44
What might provide a basis for prescribing biologics in rheumatoid arthritis?
failure to respond to 2 DMARDs including MTX with a DAS of \>5.1 on two ocassions, 4 weeks apart
45
Advantage to doing hand and feet x-rays in early rheumatoid arthritis?
provides a good baseline

Y2 MSK (9 decks)

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