Rheumatoid Arthritis Flashcards
what genes are associated with an increased risk to developing RA?
HLA DR4
HLA DR1
how does RA usually present?
symmetrical joint swelling and pain
morning stiffness
usually small joints of hands and feet
may have systemic features e.g. malaise
why may you get tendon rupture in RA?
tendon sheaths have a synovial lining, so tendons can rupture if the inflammation involves these sheaths
what might you see on examining the JOINTS in a patient with RA?
bilateral swollen and tender joints deformities - ulnar deviation, swan neck, boutonierres, Z thumbs muscle wasting tenosynovitis atlantoaxial subluxation
what extra articular features can you get in RA?
•Eyes: secondary Sjögren’s syndrome, scleritis, episcleritis.
•Skin: leg ulcers, rashes, nail fold infarcts.
•Rheumatoid nodules
•Resp: pleural effusion, pulmonary fibrosis
•CVS: pericardial effusion, myocardial fibrosis
other: splenomegaly, amyloidosis, raynaurds, carpal tunnel syndrome
what is Felty’s syndrome?
RA & splenomagaly & neutropaenia
what investigations would you do in RA and why?
RF - +in 70% anti-CCP - very specific ANA - + in SLE and sometimes RA FBC - anaemia, thrombocytosis ESR/CRP - raised LFT - mildly raised alk phos and gamma GT urinalysis to rule out CTD xray hands and feet
what xray changes would you expect in RA?
loss of joint space erosions deformities periarticular osteopaenia soft tissue swelling
give some differentials for bilateral joint pain
RA seronegative arthropathies e.g. psoriatic, IBD fibromyalgia SLE polymyalgia rheumatica
what tool is used to assess severity of RA?
DAS28 score
what factors does DAS28 take into consideration?
number of tender and swollen joints
patient’s score on general wellbeing (/100)
ESR
how would you manage RA pharmacologically?
simple analgesia NSAIDs steroids DMARDs Biological therapies
what are the cut off levels for the DAS 28?
> 5.1 = active disease
< 3.2 = well-controlled disease
< 2.6 = remission
how would you manage RA non-pharmacologically?
encourage exercise
physiotherapy
occupational therapy
access to specialst nurse
what other drug would you usually prescribe alongside an NSAID and why?
PPI e.g. omeprazole
to prevent GI ulceration
