Rheumatoid Arthritis Flashcards
What is rheumatoid Arthritis?
It is a systemic disease and it causes joint inflammation.
Antibodies can be measured to aid diagnosis. These can precede inflammation and can be measured years before a patient gets any symptoms.
List three symptom manifestations of RA
- lung disease
- vasculitis
- rheumatoid nodules
Main treatments for RA in both early and later stages of RA
DMARDS
steroids
NSAIDS
Treat
Assess
Target
What does this mean?
- Aim for clinical remission or low disease activity
- regularly assess disease activity using validated composite measures of disease activity that include joint assessments such as DAS28 - this can be 3 or 6 monthly
- adjust tight control of treatment until the target is reached
what are the main DMARD treatments?
- methotrexate
- hydroxychloriquine
- sulfasalazine
luflonamide can be used if others are not tolerated
How long does it take for DMARDS to have an effect and how long does it take for them to have the full effect?
- four to six weeks to see an effect
- four to six months to have a full response
What is the recommended treatment for RA
a combination of DMARDS plus steroids.
Trials have shown that a combination of DMARDS do not produce any more adverse effects than a single DMARD and it achieves better control of the disease
What is the gold standard DMARD to use in RA?
methotrexate
What pre-screening to people need to have before using methotrexate?
chest X-ray, FBC, U&E’s, LFTS. This allows us to repeat and easily identify toxicity.
What time scale do we give for a DMARD to work before switching to another?
6 months
Why is folic acid prescribed along side methotrexate?
to decrease side effects such as mouth ulcers, stomatitis, gastrointestinal and liver toxicity.
What test should be taken before prescribing azathioprine
TPMT. Thiopurine Methyltransferase.
What baselines should be taken before commencing hydroxychloroquine.
ophthalmic examination
Can women get pregnant or breastfeed when taking D-mards?
No
What baselines should be taken prior to commencing a DMARD?
height, weight, eGFR, chest X-ray, fBC, ALT/AST/albumin
What vaccines should pt get who are on a DMARD?
flu vaccine
When should DMARDS be used in extreme caution?
liver cirrhosis
When is a patient eligible for Biologic?
When they have tried at least TWO DMARDS, one has to be methotrexate.
What score is used to see if a patient is eligible for biologic and what does the score look at?
DAS 28
- It is based on the number of swollen and tender joints
- patients assessment of their condition using a visual analogue scare out of 100
- measurement of CRP
The score is based on assessing 28 joints including the hands, wrists, elbows and shoulders,
TWO DAS score of more than 5.1 approximately one month apart makes a patient eligible for biologic.
What DAS28 score does a patient need to have to make them eligible for a biologic?
a score of 5.1 on two occasions approximately 1 month apart
Patient require pre-screening before starting a biologic of
TB hep-B HIV infection counsel on pregnancy
What improvement in DAS28 score do we need to see before agreeing to continue treatment?
An improvement of 1.2 or more after 6 months of treatment.
If that has not occurred then we should discontinue treatment
CRP, WCC and neutrophils are often raised in RA? True or false?
True
RA is more common in females than males? True or false
True
