Rheumatoid Arthritis Flashcards
What gene is associated with RA?
HLA-DR4
What cells are involved in the pathology in RA?
T cells
What can trigger RA?
Infection
What is the pathophysiology of RA?
Inflammed synovium from autoimmune attack
- Increased angiogenesis leading to hyperplasia
- Immune cell infiltration
- Increased cell surface adhesion molecules
What cytokines are involved in the inflammatory process of RA?
IL-1
IL-6
TNF-a
What is the ARA criteria for RA?
- Morning stiffness that improves
- Polyarthritis - 3 + joints. Swelling of 14 possible areas
- Symmetrical
- Rheumatoid nodules
- Rheumatoid factor
- Radiological changes
- Hand arthritis (at least 1 hand)
What are the radiological findings on RA?
Periarticular erosions
Subluxation
What are the general symptoms of RA?
Fatigue
Wt loss
Anaemia
Rash
What score can be used to measure disease activity?
DAS-28
What specific deformities may be present o/e in RA?
Nodules
Boutainnaire’s deformity
Swan neck deformity
Ulnar deviation of fingers
Radial deviation of wrist
Z - shaped thumb
What inflammatory signs are seen o/e
Increased temp
Redness
Tenderness on movement
What are the signs of tenosynovitis?
Stiffness
Pain
Swelling
What are the cardiac complication of RA?
IHD
VHD
Pericarditis
What are the respiratory complications of RA?
Nodules in the lung
Increased risk of fibrosis
Bronchiolitis obliterans
What may be seen in the eye in RA?
Episcleritis
What is felty’s syndrome?
RA with HSM and thrombocytopenia
What MSK finding may be present with RA?
Carpal tunnel
What may be seen on neck X ray in RA?
Atlanto-axial subluxation
Serological tests RA
RF
Anti-cyclic citrullinated ab if RF -ve
What is ACCab an indicator of
Poor prognosis
Other bloods
ESR
CRP
Symptomatic treatment of RA?
Analgesia
NSAIDs
What is the main treatment of RA?
DMARDs
What is first line DMARD regimen?
1st - methotrexate
+ sulfasalazine
What should be tried if DMARDs fail twice?
Biologics
What biologics can be used in RA?
Anti-TNF = infliximab
Anti-IL-1
Anti-IL-6
