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2 MSK > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

what is rheumatoid arthritis

A

inflammatory joint disease affecting joints with synovium in them

affects any age group

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2
Q

what joints aren’t affected by rheumatoid arthritis and why

A

distal interphalangeal joints (DIP) as they dont have much synovium

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3
Q

are men/women more likely to be affected

A

women (3x more likely)

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4
Q

what happens when rheumatoid arthritis is left untreated

A

can lead to joint damage and irreversible deformities leading to loss of function

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5
Q

what causes rheumatoid arthritis

A

Can be genetic
potential triggers: infections, stress, smoking

depends on genetic factors and the presence of autoantibodies

HLA-DR4 mediated (MHC2 receptor)

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6
Q

what is the synovium

A

tissue inside the synovial joint capsule and tendon sheath.

makes direct contact with synovial fluid and acts as a joint lubricant.

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7
Q

signs of rheumatoid arthritis

A

swollen inflamed synovial membrane leading to bone erosion

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8
Q

what happens to the synovium in RA

A

swollen an inflamed > mass of spongy tissue>increased blood flow>more inflammation cells one osteoclasts>osteoclasts dissolve the bone

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9
Q

What is pannus

A

hypervasculated swollen, inflamed synovium

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10
Q

describe the pathogenesis of RA

A

unknown antigen presented to T cells> T cells activated>stimulated B cells and mactophages>macrophages releases cytokines and B cells release antibodies

This all leads to increased osteocyte stimulation leading to joint destruction

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11
Q

when is the window of opportunity where the disease can be modified

A

first 3 months

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12
Q

typical RA history

A

history - recent (short history) pain in the synovial joints, early morning stiffness that improves throughout the day

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13
Q

what investigations do you do for RA

A

blood test for inflammatory markers, (normocytic) anaemia, raised platlets

autoantibodies

imaging

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14
Q

Clinical examination findings in RA

A

bilateral, symmetrical swelling

difficulty forming fists

tenderness in joint

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15
Q

criteria for RA

A 
morning stiffness 
arthritis of 3 or more joint areas 
arthritis of hand joints 
symmetric arthritis 
rheumatoid nodules 
serum rheumatoid factor
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16
Q

what is seen on an X ray

A

normal in early stages, changes only seen later when there is synovium swelling

17
Q

what is the squeeze test for

A

squeeze hands/feet gentle and if there is pain there is synovitis

18
Q

what is tenosyvonitis

A

swelling of the tendons, RA can present as this

19
Q

what is trigger finger

A

finger stuck in a flex position and straightens out with a click, can be a sign of RA

20
Q

possible clinical presentations of RA

A 
tenosyvonitis
trigger finger 
carpal tunnel 
polymalalgia rheumatic 
palindromic rheumatism (comes and goes)
systemic symptoms 
poor grip strength
21
Q

what does extensor tenosynovisits look like

A

swelling on the back of the hand - wrist stays okay

must treat otherwise tendons fray and tear so patients cant extent their fingers anymore

DIP normal

22
Q

typical presentation of RA

A

DIP joints spared and synovium joints inflamed

23
Q

What autoantibodies are seen in RA

A

Rheumatoid factor
Anti-CCP antibodies (more specific)

some people with rheumatoid arthritis have no antibodies at all

24
Q

what is seen on Xray in RA

A

soft tissue swelling
erosions
inflammed synovium
periarticular osteopenia

no findings in early disease

25
Q

Ultrasound scans in RA

A

increases sensitivity for early disease
constantly superior to clinical exam

can detect up to 7 times more MCP erosions than plain x ray in early RA

useful in making treatment changes

26
Q

MRI scans

A

bone marrow oedema on MRI associated with inflammatory joint disease and a forerunner of erosion

integrity of tendons can be assent

can distinguish synovitis from effusions

can detect erosion early

can monitor disease activity

limited by cost

27
Q

what is DAS 28

A

score of joint disease severity

lower DAS less likely joint will be damage, aim for <2.6

28
Q

Management

A 
early recognition and diagnosis 
care by rheumatologist 
early treatment with disease modifying anti-rheumatic drugs 
NSAIDS and steroids 
Patient education 
multidisciplinary team involvement
29
Q

what are some disease modifying anti-rheumatic drugs (DMARDS)

A 
methotrexate 
sulfasalazine 
hydrochloroquine 
combination with MTX,SASP and HCQ
leflunomide 
penicillamine 
axathiprime
30
Q

what do DMARDS do

A

suppress bone marrow

31
Q

what are biologic agents

A 
Anti-TNF agents 
T cell receptor blockers 
B cell receptor blockers 
IL6 blocker 
JAK2 inhibitor

(inhibit various parts of the immune pathway)

32
Q

common side effect of biological agent

A

infections

33
Q

complications of non-treated rheumatoid arthritis

A

deformity of thumb
ulnar deviation of metacarpophalangeal joints
swan neck deformity of fingers

2 MSK (35 decks)

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