Rheumatoid Arthritis

Question 1

Definition of RA:

Answer 1

RA is a chronic autoimmune systemic illness characterised by a symmetrical peripheral arthritis and other systemic features

Question 2

What are the 7 classifications of RA?

Answer 2

Question 3

Give an overview of the epidemiology of RA.

Answer 3

Approx 1% populution have disease

F:M 3:1

Age of onset: peak age 4th/5th decade but may occur at any age from 16 years

Question 4

What is the suspected aetiology of RA?

Answer 4

A) Genetic: Overall incidence of RA ~1% rises to 2-4% in siblings and 12-15% in monozygotic twins. Genetic contribution to RA estimated to be ~50-60%

B) Environmental: Smoking, Chronic infection

Question 5

How does RA affect the synovial membrane?

Answer 5

Synovitis

Question 6

What immunological investigations do we need to carry out?

Answer 6

• Rheumatoid Factor (IgG, IgM)
• Anti Cyclic Citrullinated Antibodies (anti CCP, ACPA)

Question 7

What other investigations are recquired for RA?

Answer 7

Radiograph

Question 8

What are the symptoms of RA?

Answer 8

• Pain
• Stiffness
• Immobility
• Poor function
• Systemic Symptoms

Question 9

What are the clinical signs of RA?

Answer 9

• Swelling
• Tenderness
• Limitation of Movement
• (Redness)
• (Heat)

Question 10

What are systemic features of RA?

Answer 10

• Non-specific
  
  • Fatigue/lassitude
  • Weight loss
  • Anaemia
• Specific
  
  • Eyes, Lungs, Nerves, Skin, Kidneys
• Long term
  
  • CVS, Malignancy

Question 11

What score will assessment of RA involve?

Answer 11

Disease activity score

• DAS<2.4 represents clinical remission
• DAS>5.1 represents eligibility for biologic therapy

Question 12

What are the likely prognosis of RA?

Answer 12

• 75% of cases diagnosed during working life
• Approximately 33% will have stopped working within 2 years
• Approximately 50% will be unable to work due to disability within 10 years of diagnosis
• A person with RA will have, on average 40 days sick leave/year (compared with 6.5)