Rheumatoid Arthritis Flashcards
Dr S Bhat
is rheumatoid symmetrical or asymmetrical?
symmetrical
what does RA affect?
peripheral joints with synovium
NOT DIP JOINTS - spine apart from C1 and C2 joints as they have synovium
who is RA most common in?
women - 3x more common
what mutation is seen in RA?
HLA-DR4 mediated
name the triggers in RA.
infections, stress, cigarette smoking
what main structure is involved in RA?
synovium
what is the synovium in contact with?
synovial fluid
what 2 joints of the spine have synovium?
C1 and C2
name the joints affected in RA
hand, wrists, elbows, shoulders, TMJs, knees, hips, ankles, feet
what happens to the synovium in RA?
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
name the interleukins and pro inflammatory mediators in RA
TNF-alpha
IL-6
IL-1
what is affected in RA
synovium and tenosynovium
what is defined as early RA?
less than 2 years
what is the clinical features of RA?
prolonged morning stiffness
betters with movement
symmetric
small joint involvement of hands and feet
positive compression tests of MCP and MTPs
what causes early morning stiffness?
thick, protein-rich synovial fluid build up during sleep
name the classification criteria for RA
ACR/EULAR
a score of what or more is definite of RA in the ACR/EULAR classification?
> /= 6
who does gout not occur in?
women before the menopause
what does extensor tenosynovitis look like?
lump on dorsal surface of hand
what does synovitis look like?
lumps on knuckles
name the 2 auto-antibodies in RA
Rheumatoid factor - Rheumatoid IgM
Anti-CCP antibodies
what is ultrasound more sensitive for in RA?
erosions and synovitis
what is the assessment in RA called?
DAS 28
what does a DAS 28 score of >5.1 indicate?
active disease
what does a DAS 28 score of 3.2-5.1 indicate?
moderate disease
what does a DAS 28 score of 2.6-3.2 indicate?
low disease activity
what does a DAS 28 score of <2.6 indicate?
remission
name the management in treatment of RA
aspirin/NSAIDS DMARD 1 DMARD 2 DMARD 3 gradually withdraw
name the DMARDS
methotrexate sulfasalazine hydroxychloroquine combination leflunomide gold injections, penicillamine, azathioprine
name the initial drug choice in RA
methotrexate
