Rheumatoid arthritis

Question 1

How is a first presentation of rheumatoid arthritis managed?

Answer 1

Prescribe naproxen
Refer urgently to rheumatology
Bloods
Imaging

Question 2

What bloods should be done for rheumatoid arthritis?

Answer 2

FBC, U&Es, TFTs, ESR, CRP
Rheumatoid factor & anti-CCP
ANA

Question 3

Which joints does rheumatoid arthritis typically affect?

Answer 3

Wrists, MCPs and PIPs

Usually symmetrical

Question 4

What are some explanations for anaemia in rheumatoid?

Answer 4

Anaemia of chronic disease
Iron deficiency due to NSAIDs
Felty's syndrome 
Pernicious anaemia
Autoimmune haemolytic anaemia

Question 5

What is Felty’s syndrome?

Answer 5

Anaemia
Leucopaenia
Splenomegaly

Question 6

What are x-ray findings of rheumatoid?

Answer 6

Periarticular osteopenia
Erosions
Joint space narrowing
Deformity

Question 7

How is rheumatoid arthritis diagnosed?

Answer 7

ACR/EULAR RA classification criteria

1. At least one joint with definite clinical synovitis not explained by another disease
2. Score of over 6/10 - includes joint involvement, serology, inflammatory markers and duration

Question 8

What is the aetiology of rheumatoid?

Answer 8

Chronic autoimmune

Genes, environment and smoking

Question 9

How is disease activity in rheumatoid arthritis monitored?

Answer 9

DAS-28 (disease activity score)

Joint tenderness, no of swollen joints, patient assessment, acute phase response

Question 10

What is the treatment for rheumatoid?

Answer 10

Combination DMARD + steroid

Methotrexate + hydroxychloroquine

Paracetamol

MDT

Question 11

What are some extra-articular features of rheumatoid arthritis?

Answer 11

CTS, neuropathy, pleural effusion, nodules, vasculitis, Felty’s, keratoconjunctivitis sicca, lymphadenopathy