Rheumatoid Arthritis Flashcards
What is RA?
A chronic, autoimmune, systemic illness characterised by a symmetrical peripheral arthritis and other systemic features.
Associated with joint damage , disability and premature mortality.
What are some different types of RA?
Morning stiffness RA of 3 or more joint areas Symmetric arthritis Rheumatoid nodules Serum rheumatoid factor Arthritis of hands
What classification method is used for RA?
2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis.
A score of >or equal to 6-10 is needed to define RA.
4 categories of Joint involvement, Serology, Acute phase reactants and duration of symptoms.
What are some investigations for RA?
Rheumatoid factor IgG/IgM Anticyclic citrullinated antibodies (anti CCP, ACPA). X-ray Ultrasound CT
What are the symptoms of RA?
Pain Stiffness Immobility Poor function Systemic symptoms
What are the clinical signs of RA?
Swelling Tenderness Limitation of movement Redness Heat over joint
What are some systemic features of RA?
Fatigue Weight loss Anaemia Specific eye. lung, nerve , skin and kidney conditions. CVS and malignancy in chronic cases.
How is RA assessed?
Disease Activity Score
DAS <2.4 represents clinical remission
DAS > 5.1 represents eligibility for biologic therapy.
What is the prognosis for RA patients?
33% will have stopped work within 2yrs
50% will be unable to work due to disability within 10yrs of diagnosis
75% of cases are diagnosed within working life.
A person will have on average 40 sick days per year compared to 6.5.
What id DMARD therapy?
Disease modifying anti-rheumatic drug therapy.
They preserve joints by blocking inflammation.
Traditional DMARDs restrict your immune system broadly. Targeted DMARDs block precise pathways inside immune cells. The biologic drugs are produced by living cells and work on individual immune proteins called cytokines.
What are some examples of traditional DMARDs?
Azathioprine Cyclophosphamide Methotrexate Sulfasalazine Mycophenolate mofetil Cyclosporine Hydroxychloroquine sulfate Leflunomide
What are some examples of targeted DMARDs?
Apremilast
Tofacitinib
What is the initial treatment of RA?
Glucocorticoids, usually as an IM injection as most of the other medications take 1-2months to kick in.
What are some members of the MDT involved in the care of a RA patient?
Rheumatology specialist nurse Rheumatology OT Physiotherapist Pharmacist Clinical psychologist Podiatrist Orthotics
What are some other useful medications in RA treatment?
Anti B cell - Rituximab
Anti IL 6 receptor - Tocilizumab
JAK inhibtiors
Anti -TNF alphas
