Rheumatoid Arthritis Flashcards
If untreated, what are the results of RA?
Joint destruction
Deformity
Loss of function
Extra-articular complications
What gene predisposes to RA?
HLA-DR4
What environmental factors predispose to RA?
Viruses/bacterial infection
Smoking
What is the prevalence of RA in the population?
1%
Men are more likely to suffer from RA than women. T/F?
False- the opposite is true
In what ethnicities is RA more aggressive?
African American
Hispanic
What are the symptoms of RA?
Pain and stiffness which is persistent, symmetrical and affects the small joints more than the large joints
What are the signs of RA?
Synovitis
Deformities - swan neck, boutonniere, Z-thumb, ulnar deviation
Rheumatoid nodules
What are the differential diagnoses of RA?
Polyarticular gout
Psoriatic arthritis
Osteoarthritis
Systemic lupus erythematous
What investigations should be conducted in a patient with suspected RA?
Non-specific laboratory conditions including CRP/ESR, EFB and bone/uraate profiles Immunology lab invetsigations Plain radiographs Ultrasound MRI
What is rheumatoid arthritis?
IgM antibody which is directed against the Fc portion of IgG antibodies
In what conditions is rheumatoid factor present?
RA SLE Sjogren's Hepatitis B and C Bacterial endocarditis Increasing age
Describe the role of CPP antibodies in RA?
Cause inflammation and cellular damage
Enzymatic process leads to the conversion of arginine residues to cirtrulline. The alteration of shapes creates a foreign antigen from self-anti citrullinated cyclic peptide antibodies.
What score is required in the EULAR classification criteria to diagnose RA?
6 or more
What factors are assessed in the EULAR classification criteria of RA?
Number of joints involved
Presence of RF or anti-citrullinated protein antibodies
Presence of acute phase proteins
Duration of symptoms
What are the first changes seen on X-Ray due to RA?
Peri-articular osteopeania
Soft tissue swelling
What are the late changes seen on X-Ray due to RA?
Erosion
Joint destruction
Subluxation
What are the aims of treatment in RA?
Reduce inflammation
Maintain joint function
Prevent progression
What drugs can be used to to reduce inflammation in RA?
NSAIDs
COX-2 inhibitors (etoricoxib)
Steroids (oral, intramuscular or interarticular)
What steroids can be given IM or intraarticularly in the treatment of RA?
Depomedrone
Kenalog
Patients with RA should be offered classical disease modifying drugs within 3 months of symptom onset. T/F?
True
Patients with RA should be offered classical disease modifying drugs within 3 months of symptom onset. Give examples of these drugs?
Methotrexate
Leflunomide
Sulfasalazine
Hydroxycholoroquinine
What is the action of methotrexate?
Folate antagonist
The use of methotrexate to treat RA requires monitoring of…?
LFTs
FBC
Which classical disease modyfying drugs used in the treatment of RA are suitable for use in pregnancy?
Sulfaslazine
Hydroxychloroquinine
What are the side effects of methotrexate?
GI effects
What is the action of sulfasalazine in the treatment of RA?
Actions against folate, T and B cells
The use of sulfasalazine to treat RA requires monitoring of…?
FBC
LFTs
U&Es
What are the side effects of sulfasalazine?
GI effects
rash
headache
What is the action of hydroxychloroquinine in the treatment of RA?
Blocks toll like receptors on PDCs
What are the side effects of hydroxychloroquinine?
Headahce
Nausea
Muscle pain
Rash
The use of hydroxychloroquinine to treat RA requires monitoring of…?
Occular monitoring every 5 years
Screening for which diseases is required before initiation of biologic disease modifying anti-rheumatic drugs?
Hepatitis
HIV
Varicella
CXR
What are the contraindications for the use of biologic disease modifying anti-rheumatic drugs?
Active infection Active or latent TB Pregnancy Malignancy Diverticular disease
