Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis?
an inflammatory autoimmune condition where a combination of genetics and environmental factors lead to an inflamed synovial membrane and irreversible damage to the joints involved
explain the pathogenesis of RA?
- enough exposure to environmental factors (smoking) in someone who is genetically predisposed to RA leads to altered DNA transcription which produces differently shaped proteins
- immune system recognises these proteins as foreign so antibodies are produced against them and immune complexes are deposited in the synovium
- triggers massive inflammatory reaction which leads to thickening on the synovisl membrane which eats into the bone and causes irreversible damage
give 3 extra-articular manifestations of RA?
- interstitial lung disease (fibrosis)
- pleural effusion
- scleritis
How long does morning stiffness last for in RA?
> 30 mins (hours usually)
which joints are affected in RA?
small joints of hands and feet, DIP joints are spared
what can be seen on X-Ray in early RA?
periarticular osteopenia (bone thinning) soft tissue swelling
which antibodies indicate RA and which is more specific?
Rheumatoid Factor & anti-CCP
Anti-CCP more specific
What is the treatment algorithm for RA?
Methotrexate 1st line
Try alternative DMARD if methotrexate not working
If 2nd DMARD not working then biologics
what is the 1st line treatment for RA?
Methotrexate
Name 3 alternative DMARDs that can be used in RA?
Sulphasalazine
Leflunomide
Hydrochloroquine
Name 2 biologics?
Infliximab
Adalimumab
What are some side effects of DMARDs?
bone marrow suppression infection liver function derangement nausea pneumonitis
What conditions are biologics contraindicated in?
pulmonary fibrosis and heart failure
What does a DAS28 score of >5.1 indicate?
active disease
What does a DAS28 score of 3.2-5.1 indicate?
moderate disease
