Rheumatoid Arthritis Flashcards
What is the definition of RhA?
Chronic inflammatory systemic disease characterised by symmetrical deforming polyarthritis and extra-articular manifestations
Associations
Female Family history Smoking Obesity HLA DR-1 and DR-4 Autoimmune diseases (Sjögren's, Raynaud's)
Overall features
Gradual onset Peripheral joints Symmetrical Painful, swelling, stiffness Warm and tender joints
Classic hand signs
Swan neck deformity
Boutonniere deformity
Z deformity of thumbs
Trigger finger
What is swan neck deformity?
MCP + DIP fixed flexion, PIP extension
What is boutonniere deformity?
MCP + DIP extension, PIP fixed flexion
What is trigger finger?
Unable to straighten finger
Extra-articular manifestations
Fatigue, fever, weight loss Elbow and lung nodules Aveolitis and bronchiolitis Pleural and pericardial effusions Carpal tunnel syndrome Peripheral neuropathy Scleritis, episcleritis
Bloods
FBC - -Hb, +platelets, +CRP, +ESR
Rheumatoid factor
Anti-cyclic citrullinated peptide antibodies
What is rheumatoid factor?
Monoclonal IgM against Fc portion of IgG
In how many people with RhA are RhF positive?
70%
Joint X-ray
"LESS" Loss of joint space Erosions Subchondral Cysts Soft bone swelling and osteoporosis
What are the 3 categories of pharmacological treatment?
DMARDs
Biological agents
Symptomatic
What are the 3 gold-standard DMARDs and what they do?
Methotrexate - antifolate
Sulfasalazine - immunosuppressant
Hydroxychloroquine - TLR blocker
Other possible DMARDs?
Azathioprine - inhibits purine synthesis
Penicillamine - T-cell inhibitor
Cyclophosphamide - alkylating agent
Biological agents
Anti-TNFa - etanercept, infliximab
Anti-CD20 - rituximab
Drugs for symptoms
NSAIDs
Steroids
Indication for steroids
Severe extra-articular disease
