Rheumatoid Arthritis

Question 1

name the 4 groups that inflammatory arthropathies can be subdivided into

Answer 1

seropositive
seronegative
infectious
crystal deposition disorders

Question 2

type of pharmacological treatment for inflammatory arthropathies?

Answer 2

simple analgesia
steroids and steroid injections
NSAIDs
DMARDs - disease modifying anti-rheumatic drugs

Question 3

is RA symmetrical?

Answer 3

yes

Question 4

is psoriatic arthritis symmetrical?

Answer 4

no

Question 5

where does AS affect?

Answer 5

spine mainly but also shoulder, hip and knee

Question 6

features of inflammatory arthritis:

____ and swelling

________ stiffness

improvement with ________

synovitis

raised ____________ markers such as ___ and __

Answer 6

features of inflammatory arthritis:

PAIN and swelling

MORNING stiffness

improvement with EXERCISE

synovitis

raised INFLAMMATORY markers such as CRP and PV

Question 7

name the most common seropositive arthritis

Answer 7

RA

Question 8

what is RA?

Answer 8

auto‐immune inflammatory symmetric polyarthropathy

Question 9

what does RA affect?

Answer 9

small joints of hand and feet but also large joints such as knees, shoulders and elbows

Question 10

what sex is more affected by RA?

Answer 10

females

Question 11

peak age range or RA?

Answer 11

35-50

Question 12

are genetics important in RA?

Answer 12

yes - 2-3x higher risk is family member is affected

Question 13

what lines the synovial joints?

Answer 13

synovium - this is attacked in RA

Question 14

name triggers of RA

Answer 14

smoking, infection and trauma lead to disease process of immune response against the synovium

Question 15

an inflammatory ______ forms which attacks and denudes articular cartilage leading to joint destruction

Answer 15

an inflammatory PANNUS forms which attacks and denudes articular cartilage leading to joint destruction

after synovium is attacked

Question 16

what can rupture in RA?

Answer 16

tendon rupture and soft tissue damage can occur leading to joint instability and subluxation

Question 17

name the 2 antibodies important RA

Answer 17

rheumatoid factor and anti-CCP (anti-citrullinated protein antibody)

Question 18

clinical features of RA in hand(s)?

Answer 18

symmetrical synovitis (doughy swelling)
pain
morning stiffness

Question 19

what joints are affected in the hand in RA?

Answer 19

MCPs and PIPs

NOT DIPs

Question 20

what part of the spine is affected in late RA?

Answer 20

cervical spine - atlanto-axial subluxation which can result in cervical cord compression

Question 21

what skin manifestation is found in 25% of those with RA?

Answer 21

rheumatoid nodules - extensor surfaces

Question 22

lung involvement of RA?

Answer 22

pleural effusions, fibrosis and pulmonary nodules

Question 23

is CVS risk and mortality increased in those with RA?

Answer 23

yes

Question 24

is ocular involvement common in those with RA?

Answer 24

yes

keratoconjunctivitis sicca
episcleritis
uveitis
nodular scleritis that may lead to scleromalacia

Question 25

what antibody is more specific in those with RA?

Answer 25

anti-CCP

Question 26

what markers are raised in RA?

Answer 26

CRP and PV

Question 27

early XR features of RA?

Answer 27

peri-articular osteopenia and soft tissue swelling periarticular erosion in later disease

Question 28

what scan may be useful in detecting synovial inflammation if there is clinical uncertainty?

Answer 28

US

Question 29

what treatment should be initiated in a 3 month onset of RA?

Answer 29

DMARDs

Question 30

short term treatment for RA?

Answer 30

simple analgesia NSAIDs IM/IA/oral steroids

Question 31

first line DMARD for RA?

Answer 31

methotrexate

Question 32

other DMARDs for RA?

Answer 32

sulphasalazine, hydroxychloroquine and leflunomide

Question 33

what do DMARDs cause?

Answer 33

immunosuppression - increased risk of infection and marrow suppression

Question 34

monitoring of what is required for DMARD therapy?

Answer 34

blood

Question 35

what if DMARDs don't work in RA?

Answer 35

biologics anti-TNF toclizumab, rituximab and abatacept

Question 36

main increased risk of in biologics use?

Answer 36

TB

Question 37

what scoring system is used in RA?

Answer 37

DAS28/DAWN

Question 38

DAS 28 < 2.6 = Remission DAS 28 2.7-3.2 = Low disease activity DAS 28 3.3-5.1 = Moderate disease activity DAS 28 >5.1 = High disease activity which do you need for biologics?

Answer 38

DAS 28 >5.1

Question 39

can the following be treatments in RA: ``` synovectomy joint replacement joint excision tendon transfers arthrodesis (fusion) cervical spine stabilisation ```

Answer 39

yes

Question 40

physiotherapists, occupational therapists, podiatrists and orthotists do not have an important role in RA treatment true or false?

Answer 40

false