Rheumatoid Arthritis

Question 1

What is RA

Answer 1

• Autoimmune
  -Chronic
  -Progressive
  -Systemic
  inflammatory disorder

Question 2

who is affected

Answer 2

-more common in women and those 30-50yrs

Question 3

cause

Answer 3

unknown

Question 4

RA vs Osteo arthiritis

Answer 4

RA - inflammatory disorder
OA- caused by wear and tare of bones with ageing

RA- symmetrical polyarthritis (impacts over 5 joints)
OA- asymmetrical

RA- pain + stiffness of joints in hands, feet, knees
OA-often waist and knees

Question 5

RA long term effect

Answer 5

• limited movement which leads to muscle wasting
• can dev into swan neck joints
• can dev rheumatoid nodules which can be very painful

Question 6

Does RA only impact joint

Answer 6

No has other non-articular (non-joint) effects

Question 7

RA pathophysiology

Answer 7

• inflammation of synovial fluid (area between bones) due to unknown cause this pushes the bones closer together causes cartilage erosion
• cartilage thins this exposes the bone underneath
• inflammation increases macrophages, B-cells, T -cells, cytokines ( IL-1, IL-6, TNFa) in the areas
• Rheumatoid factor stimulates macrophages

Question 8

Diagnosis of RA

symptoms

Answer 8

-symptoms: gradual onset, symmetrical

Question 9

diagnosis of RA - Clinical markers

Answer 9

increased ESR + CRP (CRP increases quicker) + increase in platelets- present in all inflammation not just RA

• Rheumatoid factor (found in 80% cases)
• anti-CCP (90% cases)
• X-ray = detect late stage RA
• MRI= good at detecting early stages of RA

Question 10

monitoring RA using DAS28

Answer 10

DAS28 (disease activity score)
looks at 4 parameters

• swollen joints/ 28 specific joints
• tender joints/28
• ESR
• patient’s interpretation of wellbeing 100 is worst

Question 11

when are biological drug used for RA

Answer 11

if DAS28 greater than 5.1

Question 12

management RA

Answer 12

• symptomatic relief +pain relief use NSAIDs these reduce pain before DMARD start working
• Corticosteroids, biologics, DMARDs = slow progression of RA, preserve function, sustain/ achieve remission

Question 13

Corticosteroid use

Answer 13

• inhibit cytokine release= reduce inflammation
• work faster than DMARDs.

-Long term use has side effects like osteoporosis, adrenal suppression (need to withdraw slowly)

Question 14

DMARDs

Answer 14

• this is first line treatment often combination of 2 DMARDs used
• should be started 3 months within detecting symptoms = to preserve as much function as possible

Question 15

biologicals

Answer 15

• used only if DMARDs fail as very expensive
• TNFa blockers biologicals are the first line
• all given via injection
• only carry on if improvements in DAS28
• can be given along DMARDs