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Week A11 - MSK > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis? [4]

A

Inflammatory autoimmune disease which is symmetrical and involves multiple, small joints

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2
Q

What are the symptoms of rheumatoid arthritis? [6]

A
  1. Pain
  2. Stiffness
    • early morning stiffness
    • joint gelling
  3. Swelling
  4. Small joints > large joints
  5. Symmetrical
  6. Persistent
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3
Q

What are the signs of rheumatoid arthritis? [6]

A
  1. Synovitis
  2. Deformity
    • Swan neck → hyperextension of PIP and flexion DIP
    • Boutonniere → hyperextension of DIP and MCP with flexion PIP
    • Z-thumb
    • Ulnar deviation
  3. Rheumatoid nodules
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4
Q

Who is at increased risk of developing rheumatoid arthritis? [2]

A
  1. more common in 6th and 7th decades
  2. more common in females (2/3)
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5
Q

What are the differential diagnoses for rheumatoid arthritis? [4]

A
  1. Polyarticular gout
  2. Psoriatic arthritis
  3. Osteoarthritis
  4. Systemic lupus erythematous (SLE)
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6
Q

List the investigations used in a patient with suspected rheumatoid arthritis under the following headings:

  1. non-specific lab tests? [5]
  2. specific lab tests? [1]
  3. imaging? [3]
A
  1. Non-specific lab tests:
    • CRP/ESR
    • FBC
    • Bone/urate
  2. Specific lab tests:
    • Immunology
  3. Imaging:
    • Plain radiograph
    • Ultrasound
    • MRI
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7
Q

What antibody is associated with RA? [1]

A

ACPA (anti-CCP antibody)

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8
Q

Which 2 antibody tests can be done for RA? [2]

A
  1. Rheumatoid factor
  2. ACPA (anti-CCP)
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9
Q

What is Rheumatoid Factor and what conditions can it be present in? [7]

A
  1. Definition:
    • IgM antibody directed against the Fc portion of IgG antibody forms rheumatoid factor
  2. Present in:
    • SLE
    • Sjogren’s
    • PBC
    • Hepatitis B & C
    • Bacterial endocarditis
    • Increasing age
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10
Q

Name and describe the classification criteria used for rheumatoid arthritis

A

EULAR 2010 Classification Criteria

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11
Q

Describe the radiological changes that occur with rheumatoid arthritis under the following headings:

  1. early RA? [1]
  2. first pathological changes? [2]
  3. late pathological changes? [3]
A
  1. Early RA
    • x-rays likely to be normal
  2. First pathological changes
    • Peri-articular osteopenia
    • Soft tissue swelling
  3. Late pathological changes
    • Erosion
    • Joint destruction
    • Subluxation (incl A-A)
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12
Q

What initial therapy is given to patients with rheumatoid arthritis to reduce inflammation? [5]

A
  1. NSAIDs — Ibuprofen, naproxen, diclofenac
  2. COX-2 inhibitors e.g. Etoricoxib
    • contraindicated in:
      • renal impairment
      • anti-coagulation
    • unattractive in:
      • elderly patients
      • those with CV risk
  3. Steroids
    • Oral e.g. prednisolone
    • Intramuscular — Depomedrone (methylprednisolone) or Kenalog (triamcinolone acetonide)
    • Intra-articular — Depomedrone or Kenalog
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13
Q

List the 4 types of cDMARDs and state when they should be given [5]

A
  • Patients should be offered cDMARDs first line and within 3 months of symptom onset:
    1. Methotrexate
    2. Leflunomide
    3. Sulfasalazine
    4. Hydroxychloroquine if mild or palindromic disease
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14
Q

Describe methotrexate under the following headings:

  1. mechanism of action? [1]
  2. how often taken? [1]
  3. side effects? [2]
  4. monitoring requirements? [2]
  5. safe in pregnancy? [1]
A
  1. Folate antagonist
  2. Once weekly
  3. Side effects
    • usually mucosal or GI
  4. Monitoring requirements
    • FBC
    • LFTs
  5. Contraindicated in pregnancy
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15
Q

Describe sulfasalazine under the following headings:

  1. mechanism of action? [1]
  2. how often taken? [1]
  3. side effects? [3]
  4. monitoring requirements? [3]
  5. safe in pregnancy? [1]
A
  1. Immunomodulatory, several actions including against folate, T and B cells
  2. Daily → pill burden
  3. Side effects
    • GI side effects
    • headache
    • rash
    • (step-up dosing)
  4. Monitoring requirements
    • FBC
    • U&Es
    • LFTs
  5. Safe in pregnancy (folic acid 10mg daily, started 3 months pre-conception)
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16
Q

Describe hydroxychloroquine under the following headings:

  1. mechanism of action? [1]
  2. how often taken? [1]
  3. side effects? [4]
  4. monitoring requirements? [1]
  5. safe in pregnancy? [1]
A
  1. Blocks toll-like receptors on PDCs
  2. Daily - most benign DMARD
  3. Side effects
    • headache,
    • nausea,
    • muscle pain,
    • rash
  4. Monitoring requirements
    • ocular after 5 years
  5. Safe in pregnancy

Week A11 - MSK (13 decks)

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