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BPT Rheumatology > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

What is the reduced life-expectancy in RA

A

7-10 years - CV disease

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2
Q

Which alleles confer susceptibility in Anti-CCP positive RA

A 
HLA-DRAB1*01
HLA-DRAB1*04
HLA-DRAB1*15
CTLA4
STAT4
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3
Q

Which alleles confer susceptibility in Anti-CCP negative RA

A

HLA-DRAB103
HLA-DRAB113
IRF5
STAT 4

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4
Q

Which environmental risk factor increase risk in lung?

A

Smoking

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5
Q

Which environmental risk factor increase risk in mouth?

A

Periodontal disease

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6
Q

Which environmental risk factor increase risk in GIT?

A

Microbiome

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7
Q

What are Rheumatoid Factors?

A

Antibodies directed against Fc portion of human IgG

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8
Q

What are Anti-CCP antibodies?

A

Highly specific antibodies against citrullinated proteins that are the hallmarks of the immune response to RA

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9
Q

What manifestations are associated with ACPA?

A

More severe and destructive disease

RA-related interstitial lung disease and CVD

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10
Q

Which epigenetic factors interact/trigger?

A

Synovial fibroblast-like synoviocytes

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11
Q

Which are the major cytokines involved in pathogenesis

A

TNF
IL-17A/F
IL-1
IL-6

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12
Q

What signalling factor mediates bone damage?

A

RANK ligand

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13
Q

What are the clinical features?

A

Asymmetric, insidious onset
Morning stiffness
Small joints first

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14
Q

Which joints are typically spared?

A

DIPs

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15
Q

What is Palindromic rheumatism?

A

Articular pain then swelling and erythema
Symptoms wrose for hours to a few days
Then resolve in reverse sequence

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16
Q

What percentage of pt with palindromic rheumatism go onto dev RA?

A

50%

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17
Q

What is more common in elderly?

A

Stiffness ? synovitis

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18
Q

What is RS3PE?

A

Remitting, seronegative, symmetric synovitis with pitting oedema syndrome

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19
Q

What are the clinical and serological features of RS3PE?

A

Oedema of dorsum of hand or foot (boxing glove appearance)
Tenosynovitis
Seronegative for RF and ACPA

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20
Q

What is the underlying concern with RS3PE?

A

Can be paraneoplastic

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21
Q

Which direction does the wrist deviate?

A

Radially

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22
Q

Which direction do the fingers deviate at the MCPs?

A

Ulnar

23
Q

Which direction do the finger joints go with Swan neck?

A

PIP herniates in volar direction

Flexion at DIP

24
Q

Which direction do the finger joint go with Boutonniere deformity?

A

PIP flexion to rupture of extensor tendons
DIP extension

(opposite to swan neck)

25
Q

Which foot joint is effected first in feet?

A

5th MTP commonly

26
Q

What are the derm manifestations

A

Rheumatoid nodules
Vasculitis
Ulcers
Neutrophilic dermatosis

27
Q

What are the ophthalmic manifestations

A

Episcleritis
Scleritis
Perilimbic ischaemic ulcers
Secondary Sjogren’s syndrome

28
Q

What are the pulmonary manifestations?

A 
Pleuritis
Pleural effusions 
Nodules
NSIP/UIP
Bronchiectasis
29
Q

What are the CV manifestations?

A

Premature atherosclerosis

Pericarditis, pericardial effusion

30
Q

What are the radiographic characteristics?

A 
Periarticular soft tissue swelling
Juxta-articular osteoporosis
Marginal erosions
Joint space narrowing
Symmetric involvement 
Deformities
31
Q

What does Power Doppler positivity portend?

A

Progression to erosive disease

32
Q

When do you consider biological DMARDs?

A

Active disease after two or more conventional DMARDs for 6 months

33
Q

What is the ACR70 response rate of methotrexate?

A

20-40%

34
Q

What dose cut off such subcut MTX be considered?

A

15mg/week

35
Q

What AEs for MTx?

A 
Nausea
Ulcer
Abnormal LFTs
Cytopenia
Pneumonitis 
Teratogenicity
36
Q

How much EtOH can be consumed without increasing risk of transaminitis?

A

<14units per week

37
Q

How is methotrexate excreted?

A

Renally

38
Q

Which medication shouldn’t MTx be combined with

A

Trimethoprim

39
Q

What is hte ACR70 response rate of sulfalazine

A

8%

40
Q

Common AEs of ssz?

A 
Hypersensitivity reaction
Nausea
Diarrhoea
Agranulocytosis
Drug-induced lupus
Azoospermia
41
Q

AE of hydroxychloroquine?

A

Hyperpigmentation
Retinopathy
Myopathy and cardiomyopathy

42
Q

What is hte mech of leflunomide?

A

Inhibit DHODH (dihydroorate dehydrogenase)

43
Q

AE of leflunomide?

A 
Diarrhoea (~25%)
Hypertension
Hypersensitivity
LFTs and pneumonitis esp. when w MTx
Leukocytopenia
Teratogenicity
Peripheral neuropathy
44
Q

Which biologics inhibitor TNF?

A 
Infliximab
Etanercept
Adalimumab
Golimumab
Certolizumab
45
Q

What is the ACR70 response rate of TNFi

A

20%

46
Q

Which TNFi is safest in pregnancy?

A

Certolizumab

47
Q

What relative contraindications are their for TNFi

A 
SLE
Demyelinating disorder
Infections
CCF
Pregnancy
48
Q

TNFi AE

A 
Infection
Malignancies - skin and lymphoma
Demyelinating conditions
Lupus-like syndrome
Hepatic
Dermatologic reaction
49
Q

What is the mechanism of abatacept?

A

CD80 and CD86 inhibitor

50
Q

What is the mech of tocilizumab

A

IL-6 receptor inhibitor

51
Q

Which biologic effects CRP?

A

Tocilizumab

52
Q

Which medications are the JAK inhibitors?

A

Tofacitinib and baricitinib

53
Q

Which infection in particular do you get with JAK inhibitors?

A

Herpes zoster

BPT Rheumatology (17 decks)

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