Rheumatoid Arthritis Flashcards
What is RA?
Rheumatoid arthritis
Autoimmune condition which causes inflammation of the synovium
Which joints are more commonly affected by RA?
Small joints
- MCPs
- PIPs
- MTPs
What is the distribution of RA?
Bilateral
When is RA worse?
Morning stiffness >30mins
What genes are associated with RA?
HLA DR1
HLA DR4
What is a pannus?
Pannus is formed in RA when the inflammed synovium becomes hypertrophied
What are signs of RA?
Rheumatoid nodules
Swan neck deformity
Z thumb
Boutonniere deformity
What are rheumatoid nodules?
Fibrinoid necrosis
What is a swan neck deformity?
DIP flexion with PIP hyperextension
What is a Boutonniere deformity?
PIP flexion with DIP hyperextension
What are the extra-articular manifestations of RA?
Carpal tunnel syndrome
Cardiac risk
Cord compression
Anaemia
Amyloidosis
Arteritis
Pericarditis
Pleural disease
Pulmonary disease
Sjogren’s
Sceleritis/episceleritis
Splenomegaly
What is Felty’s syndrome?
Triad of
- RA
- splenomegaly
- neutropenia
What is the difference between scleritis and episceleritis?
Sceleritis
- red
- deeper vessels
- painful
- risk of perforation
Episceleritis
- shallower
- less painful
- red
What is the diagnostic criteria for RA?
4 out of 7
- morning stiffness >1hour
- arthritis >3 joints
- arthritis of hands
- symmetrical
- rheumatoid nodules
- +RF
- x-ray changes
What are the x-ray changes in RA?
Loss of joint space
Erosions (juxta-articular)
Soft tissue swelling
Subluxation
What causes juxta-articular erosions?
TNF-a stimulates osteoclast differentiation
Osteoclasts cleave bone
What is the scoring system for RA management?
DAS-28
What investigations would you do for suspected RA?
FBC CRP ESR Anti-CCP RF
Which antibody is better?
Anti-CCP
How is RA managed?
DMARDs
- methotrexate
- sulfasalazine
Anti-TNF
- infliximab
- adalimub
Steroids
NSAIDs
What is a side effect of methotrexate?
Myelosuppression
What do you need to take with methotrexate?
Folic acid
Methotrexate = anti-folate
