Rheumatoid Arthritis

Question 1

is rheumatoid symmetrical or asymmetrical?

Answer 1

symmetrical

Question 2

what does RA affect?

Answer 2

peripheral joints with synovium

NOT DIP JOINTS - spine apart from C1 and C2 joints as they have synovium

Question 3

who is RA most common in?

Answer 3

women - 3x more common

Question 4

what mutation is seen in RA?

Answer 4

HLA-DR4 mediated

Question 5

name the triggers in RA.

Answer 5

infections, stress, cigarette smoking

Question 6

what main structure is involved in RA?

Answer 6

synovium

Question 7

what is the synovium in contact with?

Answer 7

synovial fluid

Question 8

what 2 joints of the spine have synovium?

Answer 8

C1 and C2

Question 9

name the joints affected in RA

Answer 9

hand, wrists, elbows, shoulders, TMJs, knees, hips, ankles, feet

Question 10

what happens to the synovium in RA?

Answer 10

inflamed by antigen so increased blood flow so more inflammatory markers so inflamed synovium attracts osteoclasts so eats bone so diffuse erosion of cartilage and bone

PANNUS

Question 11

name the interleukins and pro inflammatory mediators in RA

Answer 11

TNF-alpha
IL-6
IL-1

Question 12

what is affected in RA

Answer 12

synovium and tenosynovium

Question 13

what is defined as early RA?

Answer 13

less than 2 years

Question 14

what is the clinical features of RA?

Answer 14

prolonged morning stiffness

betters with movement

symmetric

small joint involvement of hands and feet

positive compression tests of MCP and MTPs

Question 15

what causes early morning stiffness?

Answer 15

thick, protein-rich synovial fluid build up during sleep

Question 16

name the classification criteria for RA

Answer 16

ACR/EULAR

Question 17

a score of what or more is definite of RA in the ACR/EULAR classification?

Answer 17

> /= 6

Question 18

who does gout not occur in?

Answer 18

women before the menopause

Question 19

what does extensor tenosynovitis look like?

Answer 19

lump on dorsal surface of hand

Question 20

what does synovitis look like?

Answer 20

lumps on knuckles

Question 21

name the 2 auto-antibodies in RA

Answer 21

Rheumatoid factor - Rheumatoid IgM

Anti-CCP antibodies

Question 22

what is ultrasound more sensitive for in RA?

Answer 22

erosions and synovitis

Question 23

what is the assessment in RA called?

Answer 23

DAS 28

Question 24

what does a DAS 28 score of >5.1 indicate?

Answer 24

active disease

Question 25

what does a DAS 28 score of 3.2-5.1 indicate?

Answer 25

moderate disease

Question 26

what does a DAS 28 score of 2.6-3.2 indicate?

Answer 26

low disease activity

Question 27

what does a DAS 28 score of <2.6 indicate?

Answer 27

remission

Question 28

name the management in treatment of RA

Answer 28

aspirin/NSAIDS
DMARD 1
DMARD 2
DMARD 3
gradually withdraw

Question 29

name the DMARDS

Answer 29

methotrexate
sulfasalazine
hydroxychloroquine
combination
leflunomide
gold injections, penicillamine, azathioprine

Question 30

name the initial drug choice in RA

Answer 30

methotrexate