Rheumatoid arthritis Flashcards
How many phases of RA are there?
two: acute and chronic
What is the acute phase of RA?
pannus formation (inflammatory granulation tissue)
What is the chronic phase of RA?
fibrosis
What gene mediates RA?
HLA-DR4
What is the therapeutic window of opportunity for RA?
first 3 months
What is the pathophysiology of RA?
type 4 hypersensitivity reaction - infiltration of the synovium by self reactive CD4 T cells, then B cells and autoantibodies are involved
How is RA disease activity assessed?
DAS score
>5.1 = active
<2.6 = remission
What is the ACR criteria for RA
morning stiffness arthritis of > 3 joints hand joints rheumatoid nodules radiographic changes
Signs of RA?
positive MCP and MTP compression tests symmetric distribution tenosynovitis carpal tunnel trigger finger buchards nodes
Investigations for rheumatoid?
Inflammatory markers
autoantibodies - rheumatoid factor, anti CCP
blood tests - increased platelets and anaemia
imaging - Xray
Risk factors for RA?
women x3
smoking
stress
Treatment for RA?
Aspirin or NSAID THEN DMARDs - methotrexate or sulfasalazine THEN Biologics if failure to respond to 2 DMARDs and DAS >28 - Infliximab
Steroids as bridging therapy and for flares
What DMARD is safe for pregnancy?
Sulfasalazine
What are rheumatoid nodules?
appear around arthritic joints due to repetitive trauma
present with increased inflammatory markers
Are rheumatoid nodules RF +ve or -ve?
+ve
