Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

Systemic inflammatory arthritis, leading to joint damage, deformity + systemic symptoms

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2
Q

What sex and age range does rheumatoid arthritis tend to affect?

A

Females 3:1 males

30-50 yrs old

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3
Q

What is the basic pathology behind rheumatoid arthritis?

A

Autoimmune inflammation of the synovium (pannus); Inflammatory mediators activate osteoclasts causing bone erosion

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4
Q

List classic symptoms and signs of rheumatoid arthritis

A
Joint pain/swelling
Stiffness in the morning
Systemic features
Symmetrical tenderness
Reduced movement
Deformities of small joints
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5
Q

Rheumatoid arthritis usually affects less joints than osteoarthritis. True/False?

A

False

Usually affects more joints

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6
Q

List investigations for rheumatoid arthritis

A

Anti-CCP, rheumatoid factor
Inflammatory markers
USS (early)

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7
Q

List some poor prognostic indicators for rheumatoid arthritis

A
Young age
Male
Many active joints
High CRP
Early erosions
Extraarticular features
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8
Q

What is the “window of opportunity” of treating rheumatoid arthritis, where treating in this period can prevent irreversible damage to joints?

A

3 months

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9
Q

What is the main treatment of rheumatoid arthritis?

A

DMARDS (up to 3)

Biological agents if ineffective

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10
Q

What 4 other groups of biological agents have been effective for rheumatoid arthritis?

A

Anti-TNF (infliximab)
B cell depletors (ritixumab)
IL-6 inhibitor (tocilizumab)
T cell distruptors (abatacept)

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11
Q

List features suggestive of joint inflammation

A

Joint pain
Swelling
Morning stiffness
Improvement with exercise

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12
Q

What is the most prevalent seropositive arthropathy?

A

Rheumatoid arthritis

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13
Q

There is a genetic component to RA. True/False?

A

True

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14
Q

List clinical features of RA

A

Symmetrical synovitis
Rheumatoid nodules
Deformities of small joints

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15
Q

Which joints in the hand are affected my RA?

A

MCP
PIP
Wrist

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16
Q

XR is useful at the onset of RA. True/False?

A

False

Often shows no joint abnormality in early stages

17
Q

When are steroids used in the treatment of RA? Give an example

A

In flares

Methylprednisolone

18
Q

RA typically affects proximal/distal joints

19
Q

RA usually involves sparing of the ___ joints

20
Q

List precipitating factors for RA

A

Infections
Stress
Smoking

21
Q

List some systemic features of RA

A

Trigger finger
Carpal tunnel syndrome
Polymalgia rheumatica

22
Q

What are the findings of RA on imaging?

A

Soft tissue periarticular osteopaenia

Erosions

23
Q

What scoring system is used in RA? What score suggests active disease? What score suggests remission?

A

Disease activity score (DAS 28)
> 5.1
< 2.6

24
Q

What is the most common DMARD used in RA? Which medication should be prescribed in conjunction with this drug?

A

Methotrexate

Folic acid

25
What is palindromic rheumatism? What DMARD is typically used to treat it?
Short arthritic episodes | Hydroxychlorquine
26
What other medications are used in the treatment of rheumatoid arthritis?
Leflunomide Gold injections Pencillamine Azathioprine
27
What side effects of methotrexate should be considered before prescribing, and how should these be monitored?
``` Liver function (LFTs) Risk of pneumonitis (CXR) ```
28
What is the main side effect of DMARDs?
Teratogenic
29
List some complications of untreated RA
Atlanto-axial subluxation Boutanniere thumb Ulnar deviation of MCP Swan neck fingers
30
What other considerations should be made in long-term RA?
Osteoporosis screening Smoking cessation Immunizations CVD risk
31
Rheumatoid arthritis is an example of which type of hypersensitivity?
Type IV