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MSK > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

RA Definition

A

Chronic autoimmune systemic illness

characterised by symmetrical peripheral arthritis

and other systemic features

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2
Q

RA diagnosis needs a score of x according to 2010 EULAR Classification

A

6 OR MORE out of 10

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3
Q

4 sub-categories of RA Classification/Criteria

In each sub-category, what would score high pointing to a dx of RA?

A

Joint Involvement (poly + small joints)

Serology (RF +ve, ACPA +ve)

Acute phase reactants (raised)

Duration of symptoms 6w

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4
Q

Epidemiology of RA

Gender

Prevalence

Peak age of onset

But may occur at any age from ____

A

F:M 3:1

1% of population

4th or 5th decade

But may occur at any age from 16 y

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5
Q

Aetiology RA

Genetic - closest association with specific amino acid sequences at positions ____ of _____

What are the susceptibility genes?

Environmental factors (2)

A

Genetic - closest association with specific amino acid sequences at positions 70-74 of DRb1

HLA DR1 and HLA DR4

Environmental factors:

Smoking

Chronic infection - peri-odontal disease

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6
Q

Pathogenesis RA

3 stages

A

Rheumatoid factor binding to IgG forming immune complexes

Not easily cleared

Activate complement - further inflammation

Activation of macrophages

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7
Q

RA Symptoms 4

A

Pain

Swelling

Loss of function

Systemic symptoms

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8
Q

Symptoms RA

  • Systemic symptoms
    • Non-specific (3)
A

Fatigue

Weight loss

Anemia

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9
Q

Which types of malignancy have higher incidence assoc with RA

A

Leukemia and Lymphoma

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10
Q

RA Clinical Signs (5)

A

Swelling

Tenderness

Limitation of ROM

  • Redness*
  • Heat*
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11
Q

Investigations RA (5)

A

Immunology

  • RF
  • ACPA or Anti-CCP

X-rays

USS

Raised CRP/ESR

DAS28 score

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12
Q

DAS28 score - how does it relate to RA?

What score represents clinical remission?

What score indicates eligibility for biology therapy

A

DAS28 score – monitor disease activity (disease activity score)

DAS<2.4 represents clinical remission

DAS>5.1 represents eligibility for biologic therapy

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13
Q

4 modes of management of RA

A

NSAIDS

DMARDS

Biologics

Corticosteroids

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14
Q

Name 4 DMARDs used in RA

Whats the gold standard DMARD drug

A

Methotrexate

Sulfasalazine

Hydroxychloroquine

Leflunomide

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15
Q

Name 5 drugs under ‘Biologics’ category of RA MX

A

TNF-alpha inhibitors Etanercept

IL-1 inhibitors Anakinra

IL-6 inibitors Tocilizumab

Anti-B cell therapy - Rituximab

Anti-T cell therapies - Abatacept

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16
Q

What are the extra-articular manifestations of RA? [4]

A

Extra-articular

  • Rheumatoid nodules
  • Increased risk of atherosclerosis
  • Interstitial lung fibrosis
  • Pleural effusions (SOB)
17
Q

What is Felty’s syndrome? Why can it be dangerous?

A

Triad of:

RA

Splenomegaly

Granulocytopenia

Can lead to life-threatening infections

18
Q

X-ray of RA

Early [3]

Late [3]

A

soft tissue swelling, juxta-articular osteopenia, loss of joint space

Late changes: bony erosions, subluxation, complete carpal destruction

L – loss of joint space
E – erosions
S – soft tissue swelling
S – soft bones (osteopenia)

19
Q

What finding would you see on FBC

A

Increased platelets

20
Q

DMARDs

Indications for prescribing [1]

How long before patient should expect symptomatic benefit [1]

Best results with? [3]

SE [3]

How to counter this side effect [1]

A

Should be started within 3 months of persistent symptoms

Can take 6-12w for symptomatic benefit

DMARD monotherapy +/- a short-course of bridging prednisolone (NICE, 2018)

SE: immunosupression, pancytopenia, neutropenic sepsis so regular FBC monitoring

21
Q

DMARDs side effects

Methotrexate [3]

Sulfasalazine [3]

Leflunomide [4]

Hydroxychloroquine [1]

A

Methotrexate - pneumonitis, oral ulcers, hepatotoxicity

Sulfasalazine - rash, decreased sperm count, oral ulcers

Leflunomide - teratogenicity, oral ulcers, increased BP, hepatotoxicity

Hydroxychloroquine - Bull’s eye retinopathy

22
Q

Biologics

First line? When is this indicated? [2]

Second line? [2]

Third line? [2]

A
  1. TNF alpha inhibitors - after failure of 2 DMARDs and DAS28>5.1
  2. Anti B-cell therapy - after failure of DMARDs and TNF alpha inhibitor
  3. IL6 inhibitior - after failure of TNF alpha and anti-B cell therapy
23
Q

SE profile of biologics [5]

A

Serious infection eg reactivation of TB, Hep B

Worsening heart failure

Hypersensitivity

Blood disorders

Reversible SLE-type illness may evolve

24
Q

Palindromic RA

Presentation of joint inflammation [2]

A

Episodic and sequential moving from one joint to another

Hours-days then symptom-free periods that last days-months

MSK (28 decks)

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