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Rheumatology and MSK > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

characterised by what

A

rheumatoid nodules (pathognomonic of RA

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2
Q

histopathology of rheumatoid nodules

A

Centre = fibrinoid necrosis
Then a circle of cellular palisade (densely packed layer of macrophages and fibrobasts)
Then layer of T cells and plasma cells
Outside -> Fibrous shell

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3
Q

describe inflammatory pain (this applies to RA, ank spond and any other joint inflammation…)

A

eases with use
early morning stiffness >60 mins
stiff at rest

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4
Q

what joints are never affected?

A

DIPs

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5
Q

in what diseases is there is there involvement of the DIPs

A

psoriatic arthritis
osteoarthritis
gout

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6
Q

what gene is associated with RA

A

HLA-DR4

HLA-DRB1

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7
Q

2 major pathological changes in joint RA

A

chronic synovitis

progressive erosion of articular cartilage

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8
Q

are joint effusions a transudate or exudate

A

exudate (NB exudates occur in inflammation whereas transudates occur due to increased hydrostatic pressure or low plasma oncotic pressure)

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9
Q

what bone erosion is seen in RA

A

periarticular

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10
Q

antibodies in RA

A

anti citrullinated cyclic peptide abs

rheumatoid facotr

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11
Q

onset

A

slowly progressive

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12
Q

is there joint swelling in RA

A

yes there may be

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13
Q

what joints are usually affected

A

small joints of hand and feet
can be cervical spine
polyarthropathy

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14
Q

5 hand signs

A
  • Ulnar deviation
  • Boutonniere deformity (flexion of PIP, extension of DIP)
  • Swan neck deformity (hyperextension of PIP, flexion of DIP)
  • Z-thumb (hyperextension of interphalangeal joint, fixed flexion and subluxation of MCP joint)
  • Palmer MCP subluxation (MCP dislocates so that back of hand is higher than fingers)
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15
Q

toe defomitiy

A

hammer toe (fixed flexion of both joints of toe)

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16
Q

non-articular manifestation of RA

A 
CARPALS
carpal tunnel
anaemia of chronic dis (normocytic normochromic)
raynaud's
pleural effusions and pericarditis
amyloidosis (renal)
lack of saliva (sjogren's)
scleritis + episcleritis, splenomegaly

increased risk of IHD (causes death in most)

17
Q

where do rheumatoid nodules occur

A 
pressure points
elbows
finger joints
achilles tendon
can occur in lungs
18
Q

specific Ix

A

rheumatoid factor
anti-CCP
hand feet xray

19
Q

non specific ix

A

ESR, CRP - raised
FBC - normochromic normocytic anaemia
LFTs: mild elevation of alk phs and ggt
ANA - positive in SLE and 30% RA

20
Q

referral time fram2

A

2ww

21
Q

score to measure disease activity

A

DAS28

22
Q

drugs for RA

A 
para and codeine
NSAIDs (+PPI)
short term oral steroids
steroid injection (intraarticular or IM as acute rx)
DMARDs
biologics
23
Q

examples of DMARDs

A

methotrexate
ciclosporin
sulfasalzine
hydroxychloroquine

24
Q

what combo of drugs to go for

A

methotrexate + another DMARD plus short term pred

25
Q

what are the biologics?

A

multiple types (acting on different receptors). Some are anti-TNFs
abatacept
rituximab
tocilizumab

ANTI-TNFs
adalimumab
etanercept
golimumab
infliximab
26
Q

what could a hot swollen joint mean

A

RA - sometimes the joints do become inflamed

septic arthritis - RA joints are at greater risk

27
Q

when may pt with RA need surgery

A 
persistent pain
worsening joint function
progressive deformity
tendon rupture
never entrapment
28
Q

how do many people with RA die

A

CVS disease (RA increases risk)

29
Q

findings on xray

A 
LESS
Loss of joint space
Erosions (of bone)
Soft tissue swelling
Soft bone (periarticular osteopenia)
30
Q

onset

A

4th and 5th decades

31
Q

what do rheumatoid nodules feel like

A

mobile!

range between texture of frozen pea to cooked pea.

32
Q

SEs mehtotrexate

A 
n+v
mouth ulcers
hair thinning
TERATOGENIC
folic acid reduces risk of all of these

Rheumatology and MSK (21 decks)

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