Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis?
Systemic inflammatory arthritis, leading to joint damage, deformity + systemic symptoms
What sex and age range does rheumatoid arthritis tend to affect?
Females 3:1 males
30-50 yrs old
What is the basic pathology behind rheumatoid arthritis?
Autoimmune inflammation of the synovium (pannus); Inflammatory mediators activate osteoclasts causing bone erosion
List classic symptoms and signs of rheumatoid arthritis
Joint pain/swelling Stiffness in the morning Systemic features Symmetrical tenderness Reduced movement Deformities of small joints
Rheumatoid arthritis usually affects less joints than osteoarthritis. True/False?
False
Usually affects more joints
List investigations for rheumatoid arthritis
Anti-CCP, rheumatoid factor
Inflammatory markers
USS (early)
List some poor prognostic indicators for rheumatoid arthritis
Young age Male Many active joints High CRP Early erosions Extraarticular features
What is the “window of opportunity” of treating rheumatoid arthritis, where treating in this period can prevent irreversible damage to joints?
3 months
What is the main treatment of rheumatoid arthritis?
DMARDS (up to 3)
Biological agents if ineffective
What 4 other groups of biological agents have been effective for rheumatoid arthritis?
Anti-TNF (infliximab)
B cell depletors (ritixumab)
IL-6 inhibitor (tocilizumab)
T cell distruptors (abatacept)
List features suggestive of joint inflammation
Joint pain
Swelling
Morning stiffness
Improvement with exercise
What is the most prevalent seropositive arthropathy?
Rheumatoid arthritis
There is a genetic component to RA. True/False?
True
List clinical features of RA
Symmetrical synovitis
Rheumatoid nodules
Deformities of small joints
Which joints in the hand are affected my RA?
MCP
PIP
Wrist
XR is useful at the onset of RA. True/False?
False
Often shows no joint abnormality in early stages
When are steroids used in the treatment of RA? Give an example
In flares
Methylprednisolone
RA typically affects proximal/distal joints
Distal
RA usually involves sparing of the ___ joints
DIP
List precipitating factors for RA
Infections
Stress
Smoking
List some systemic features of RA
Trigger finger
Carpal tunnel syndrome
Polymalgia rheumatica
What are the findings of RA on imaging?
Soft tissue periarticular osteopaenia
Erosions
What scoring system is used in RA? What score suggests active disease? What score suggests remission?
Disease activity score (DAS 28)
> 5.1
< 2.6
What is the most common DMARD used in RA? Which medication should be prescribed in conjunction with this drug?
Methotrexate
Folic acid
