Rheumatoid arthritis

Question 1

definition

Answer 1

chronic auto immune systemic illness characterised by a symmetrical peripheral arthritis and other systemic features

Question 2

criteria of RA

Answer 2

morning stiffness
arthritis of 3 or more joint areas
arthritis of hand joints
symmetric arthritis
rheumatoid nodules
serum rheumatoid factor
radiographic changes

Question 3

age of onset

Answer 3

peak age at 4th to 5th decade but may occur at any age from 16

Question 4

aetiology

Answer 4

genetic
genetic contribution to RA 50%- 60%
closest association with specific amino acid sequence at 70-74 of DRBeta1
-cigarette smoking
Chronic infection e.g. periodontal disease

Question 5

Pathological

Answer 5

synovitis

Question 6

immunology

Answer 6

Rheumatoid factor (largely out of date)
anti cyclic citrullinated antibodies (anti ccp more specific)

Question 7

symptoms of arthritis

Answer 7

pain 
stiffness
immobility
poor function
systemic symptoms
swelling
tenderness
limited movement

Question 8

systemic features

Answer 8

fatigue
weight loss
anaemia
Specific 
Eyes lungs, nerves skin, kidneys
CVS, malignancy

Question 9

RA: assessment

Answer 9

disease activity score
< 2.4 represents clinical remission
DAS> 5.1 represents eligibility for biologic therapy

Question 10

out come

Answer 10

life expectancy shortened by 7 years

huge negative impact on work

Question 11

treatment of arthritis

Answer 11

therapeutics

1) NSAID
2) Disease modifying anti Rheumatic drugs
3) Biologics
4) Corticosteroids

Question 12

DMARD

Answer 12

structurally unrelated, typically small molecule drugs demonstratrated to have slow onset effect of disease and retard disease progression
identifiable toxicity profiles and risk of adverse event

Question 13

DMARD

Answer 13

methotrexate
sulfasalazine
hydroxychloroquine
leflunomiede

Question 14

management of inflammatory joint disease

Answer 14

early and agressive intervention key

suppression of inflammation improve symptoms

Question 15

Methotrexate

Answer 15

effective, well tolerated and cheap
combination treatment
game changer

Question 16

treatment strategies

Answer 16

sequential monotherapy
combination: step up, step down and parallel
Treat to Target approach

Question 17

biologic DMARDs

Answer 17

typically large complex proteins which need to be given parenterally. compared to traditional
-more rapid and generally well tolerated although with important toxicities and high cost

Question 18

egs of biologics

Answer 18

TNF alpha inhibitors
IL-1 inhibitors
Anti B cell therapy
Anti T cell therapy
IL 6 inhibitors
Efficacy: enhanced response when co prescribed with methotrexate
Infection

Question 19

corticosteroids

Answer 19

short term benefit vs long term toxicity

prescribed by mouth, injection and infusion

Question 20

conclusion

Answer 20

disability, high personal and societal costs and premature death