Rheumatoid Arthritis Flashcards
What is RA
- A chronic systemic inflammatory disease
- Characterised by a symmetrical, deforming, peripheral polyarthritis
When does RA usually present
5-6th decade
RA affects men or women more
Women 2:1
Typical presentation of RA
- Symmetrical swollen, painful and stiff small joints of hands and feet
- Worse in morning
- Can fluctuate
- Larger joints may become involved
Less common presentation of RA
- Sudden onset, widespread, arthritis
- Recurrent mono/polyarthritis, of various joints
- Persistent monoarthritis (often knee, shoulder, hip)
- Polymyalgic onset (vague limb girdle aches)
- Systemic illness
Symptoms of systemic illness associated with RA
- Fever
- Fatigue
- Weight loss
- Pericarditis + pleurisy
Is systemic illness more common in men or women in RA
Men
Signs of RA
EARLY -Swollen MCP, PIP, wrist or MTP joints -Often symmetrical -Tenosynovitis or bursitis LATER -Ulnar deviation of fingers -
What are Bouchard’s nodes
- Bony swelling of PIP joints
- Due to antibody deposition to the synovium
- Also seen in OA
Extra-articular signs of RA
- Nodules (elbows + lungs)
- Vasculitis
- Lymphadenopathy
- Pleural + pericardial effusion
Investigations of RA
- Rheumatoid factor (+ve ~70%)
- ACPA/anti-CCP, highly specific (~98%)
- ESR/CRP
- X-ray/USS
What haematological condition can RA cause
Anaemia of the chronic disease (secondary disease)
Criteria for diagnosing RA
Points are given depending on the severity of each category
- Joint involvement
- Serology
- Acute phase reactants
- Duration of symptoms
Criteria for diagnosing RA regarding joint involvement
- 1 large joint = 0
- 2 large joints = 1
- 1-3 small joints = 2
- 4-10 small joints = 3
- > 10 joints (at least 1 small) = 5
Criteria for diagnosing RA regarding serology
- -ve RF + -ve anti-CCP = 0
- Low + RF/anti-CCP = 1
- High +ve RF/anti-CCP = 3
Criteria for diagnosing RA regarding acute phase reactants
- Normal CRP/ESR = 0
- Abnormal CRP/ESR = 1
Criteria for diagnosing RA regarding duration of symptoms
- <6 wks = 0
- >6 wks = 1
What score is diagnostic of RA
6 or higher
Rx for RA
- DMARDs + Biologics (improves outcomes)
- IM methylprednisolone for flare-ups(acute exacerbation)
- Oral prednisolone, can control difficult to control symptoms (can’t be used long term)
- NSAIDs, can reduce symptoms (no effect on disease progression)
Biologic Rx of RA
Infliximab (TNFalpha inhibitor)
DMARD Rx of RA
Methotrexate + Sulfasalazine + Hydroxychloroquine
