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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

A

rituximab

21
Q

Dose of methotrexate used initially in Rheumatoid arthritis?

A

15mg/week

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?

A

Anti-CCP

25
Q

X-rays in early rheumatoid arthritis may show?

A

nothing or some soft tissue swelling

26
Q

why is hydroxychloroquine prescribed alongside methotrexate?

A

it does not prevent erosions

27
Q

Ideal timescale for starting rheumatoid arthritis treatment?

A

3 months from symptom onset

28
Q

How is methotrexate best taken?

A

parenterally to provide best bioavailability i.e. IM, IV

29
Q

3rd line DMARD

A

hydroxychloroquine

30
Q

Example anti-TNF agent

A

infliximab, etanercept

31
Q

What needs to be monitored in DMARD therapy?

A

LFTs and FBCs, chest x-ray for MTX related pneumonitis

32
Q

2nd line DMARD

A

sulfasalazine

33
Q

Particularly which joints tend to be involved in early Rheumatoid arthritis?

A

PIP, MCP, wrist, MTP - synovitis

34
Q

Which joints may be affected by rheumatoid arthritis?

A

hands/wrists/elbow/shoulders, TMJ, feet/ankles/knee/hip, C1/2

35
Q

What must men and women be made aware of before starting DMARD therapy?

A

teratogenicity - must be on contraception and not use drugs 3 months prior to trying to conceive

36
Q

Gold standard test in Rheumatoid arthritis and why is it not performed more often?

A

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
Q

Autoantibody tests in rheumatoid arthritis

A

Rheumatoid factor, Anti-CCP

38
Q

What is the pathophysiology behind the inflammation in rheumatoid arthritis?

A

inflammation recruits cytokines and osteoclasts to cause joint effusion and destruction of bone

39
Q

1st line DMARD

A

methotrexate

40
Q

Genetics associated with rheumatoid arthritis

A

HLA DR4

41
Q

Main structure attacked in rheumatoid arthritis?

A

the synovium lining the synovial joints

42
Q

More advanced rheumatoid arthritis may present with…

A

swan-neck deformities, z-deformity of the thumb, ulnar deviation of the fingers

43
Q

What is the DAS-28 score?

A

the disease activity score used for monitoring rheumatoid arthritis

44
Q

What might provide a basis for prescribing biologics in rheumatoid arthritis?

A

failure to respond to 2 DMARDs including MTX with a DAS of >5.1 on two ocassions, 4 weeks apart

45
Q

Advantage to doing hand and feet x-rays in early rheumatoid arthritis?

A

provides a good baseline

Y2 MSK (9 decks)

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