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Y2 MSK > Rheumatoid Arthritis > Flashcards

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

A

Distal

19
Q

RA usually involves sparing of the ___ joints

A

DIP

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
Q

What is palindromic rheumatism? What DMARD is typically used to treat it?

A

Short arthritic episodes

Hydroxychlorquine

26
Q

What other medications are used in the treatment of rheumatoid arthritis?

A

Leflunomide
Gold injections
Pencillamine
Azathioprine

27
Q

What side effects of methotrexate should be considered before prescribing, and how should these be monitored?

A 
Liver function (LFTs)
Risk of pneumonitis (CXR)
28
Q

What is the main side effect of DMARDs?

A

Teratogenic

29
Q

List some complications of untreated RA

A

Atlanto-axial subluxation
Boutanniere thumb
Ulnar deviation of MCP
Swan neck fingers

30
Q

What other considerations should be made in long-term RA?

A

Osteoporosis screening
Smoking cessation
Immunizations
CVD risk

31
Q

Rheumatoid arthritis is an example of which type of hypersensitivity?

A

Type IV

Y2 MSK (30 decks)

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