Rheumatoid Arthritis Flashcards
Primary pro-inflammatory cytokines in RA
TNF alpha
Risk Factors for RA
Female
Smokers
Genetics (HLA-DRB chains)
Hormones (oestrogen)
Laboratory Testing for RA
RF (70% of patients - 10% of healthy individuals)
anti-CCP (cyclic cetrullinated peptide) - 60% of RA
ESR
CRP
Hb (anaemia of chronic illness)
Thrombocytosis
Hypoalbuminaemia
ANA can be positive in RA
Neutrophilia on joint aspiration
Higher levels of RF or anti-CCP = increased likelihood of disease
Clinical Features of RA
Symmetric distribution of inflammatory polyarthritis
Morning stiffness (>60mins)
Typical joint involvement - MCP and PIP, wrists
(NB: DIP and L/SP extremely uncommon)
Shoulders, hips, knees and ankles
Soft, boggy and fluctuant swelling and tenderness over the joints
Entrapment neuropathies with active inflammation or joint deformities
XR features in RA
Periarticular erosions, osteopaenia and symmetric joint-space narrowing
Erosions tend to occur first where the synovium inserts
Extra-articular manifestations of RA
Feltys Syndrome (pancytopaenia, splenimegaly and leg ulcers)
Rheumatoid nodules (deposits of rheumatoid factor)
Rheumatoid vasculitis
Interstitial Lung Disease
Scleritis / Episcleritis
Fatigue and Weight Loss
Pericarditis
Coronary Artery Disease (chronic inflammation)
Secondary Amyloidosis
Pharmacotherapy for RA
DMARDs (first line - prevent joint damage) 1. Nonbiological Methotrexate Leflunomide Hydroxychloroquine Sulfasalazine
- Biological
TNF-alpha inhibitors (etanercept, infliximab, adalimumab, golimumab, certrolizumab)
- fail one agent then swap to another in the same class
NSAIDs - symptoms
Corticosteroids - symptoms and reduction in inflammation acutely
Targets for the following biologics
Abatacept
Rituximab
Tocilizumab
Abatacept - TNF alpha
Rituximab - CD20 B Cells
Tocilizumab - IL-6 receptor antagonist
