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MSK > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

What are general symptoms and signs for arthritis/?

A 
Symptoms:
Pain
Stiffness
Swelling 
Functional impairment
Systemic symptoms
Signs:
Tenderness
Swelling
Restriction of movement
Heat
Redness
Systemic features
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2
Q

What is included in rheumatic disease?

A 
RA
Seronegative arthritis
Crystal arthritis
Connective tissue diseases
Systemic vasculitis
Bone disease
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3
Q

What is the functions of the synovium?

A

Maintenance of intact tissue surface
Lubrication of cartilage
Control of synovial fluid volume and composition
Nutrition of chondrocytes within joints

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4
Q

What happens in a joint affected by rheumatoid arthritis?

A

Erosion into corner of bone
Thinning of cartilage
Inflamed synovium spreading across joint surface
Inflamed tendon sheath

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5
Q

What is the definition of rheumatoid arthritis?

A

Chronic symmetric polyarticular inflammatory joint disease, primarily affects small joints of hands and feet

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6
Q

Where does RA primarily affect?

A

Small joints of hands and feet

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7
Q

What is the rheumatoid synovitis characterised by pathologically?

A

Inflammatory cell infiltration
Synoviocyte proliferation
Neoangiogenesis

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8
Q

What does the synovial fluid in the joint cavity contain in RA?

A

Neutrophils

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9
Q

What does the synovial pannus in RA cause?

A

Bone and cartilage destruction

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10
Q

What is RA linked to etiologically?

A

Autoimmunity

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11
Q

What do the autoantibodies in RA recognise?

A

Joint antigens e.g. type II colagen

Systemic antigens e.g. glucose phosphate isomerase

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12
Q

How do the autoantibodies in RA contribute to inflammation?

A

Activation of complement

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13
Q

What is the autoimmune reaction mediated by in seropositive RA?

A

Rheumatoid factor

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14
Q

What are cases of RA where rheumatoid factor is not present, referred as?

A

Seronegative RA

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15
Q

What is rheumatoid factor an an antibody against?

A

IgG Fc

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16
Q

What is the aetiology of RA?

A

Genetic factors
Environmental factors: smoking, infectious agents, stress
Chronic infection

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17
Q

What are examples of infectious agents associated with RA?

A

Viruses (EBV, CMV)
E.coli
Mycoplasma

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18
Q

What are bone and cartilage destruction mediated by in RA?

A

Osteoclasts

Fibroblast-like synviocytes

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19
Q

What is RA and what is it characterised by?

A

Chronic, auto immune, systemic illness

Symmetrical peripheral arthritis and other systemic features

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20
Q

What is the criteria for classifying RA?

A

1987 ARA criteria
or
2010 ACR classification

21
Q

What is the ACR classification for clinically diagnosing RA?

A 
Morning stiffness >1 hour
> 3 joints involved
Hands and wrist involvement
Symmetrical
Nodules
Positive RF
Radiological changes
Symptoms present for > 6 weeks
22
Q

Which sex is more affected by RA?

A

Female

23
Q

What is the typical age of onset of RA?

A

4/5th decade

Any age from 16

24
Q

What is the main pathological sign of RA?

A

Synovitis

25
Q

What are the immunology investigations for RA?

A

Rheumatoid factor

Anti cyclic citrullinated antibodies (Anti CCP, ACPA)

26
Q

What are investigations for RA?

A

Serology/immunology
XR
MRI
Joint aspiration

27
Q

What is the main differential for RA?

A

SLE

28
Q

What are the main symptoms of RA?

A 
Pain
Stiffness
Immobility
Poor function
Systemic symptoms
29
Q

What are clinical signs of RA?

A

Swelling e.g. elbows, wrists, MCP joints, ankles, knee effusions
Tenderness
Limitation of movement e.g. unable to lift arms
(Heat)
(Redness)

30
Q

What are the non-specific systemic features of RA?

A

Fatigue
Weight loss
Anaemia

31
Q

What are the specific systemic features of RA?

A 
Eyes
Lungs
Nerves
Skin
Kidneys
32
Q

What are the long term systemic features of RA?

A

CVS

Malignancy

33
Q

What are specific clinical features that can be described in the hands of a patient with RA?

A 
Swan-necking
Z-thumb
Subluxation of the MCP
Muscle wasting 'guttering'
Ulnar deviation
Fixed flexion deformity
34
Q

What is the scoring system for disease activity/treatment in RA?

A

Disease activity score (DAS)

35
Q

What does a DAS score of <2.4 mean in RA?

A

Clinical remission

36
Q

What does a DAS score of >5.1 mean in RA?

A

Eligibility for biologic therapy

37
Q

What bloods may be raised with RA?

A

Inflammatory markers = ESR, CRP

38
Q

What is the rheumatology review for RA?

A

Check for positive RF and positive anti-CCP antibody
Baseline hand and foot XR
Glucocorticoids
Initiation of DMARD therapy (sulfasalazine)

39
Q

What is the rheumatology follow up for RA?

A

Early arthritis clinic:

monitoring appointments, monitoring disease activity, monitoring blood tests, patient education, MDT

40
Q

What are the main DMARD’s used in RA?

A

Methotrexate

Sulfasalazine

41
Q

What is a DMARD?

A

Disease modifying anti-rheumatic drug

42
Q

What MDT are involved in RA?

A 
Rheumatology specialist nurse
Rheumatology OT
Rheumatology physio
Pharmacist
Clinical psychologist
Podiatrist
Orthotics
Rheumatology Consultant
43
Q

Apart from DMARDs what other medications can be used for RA?

A

Steroids

Symptomatic relief - analgesics

44
Q

What treatment is used in RA for patients who fail to respond to DMARDs?

A

Anti-TNF-alpha

45
Q

What are other treatment options available for RA?

A

Anti B cell: rituximab
Anti IL-6 receptor
JAK inhibitors

46
Q

What are complications of RA which might require orthopaedic intervention?

A 
Chronic synovitis
Mechanical deformities
Secondary OA
Poor function
Pain
47
Q

What are complications of RA which would have extra-articular involvement?

A

Rheumatoid nodules
Interstitial lung disease
Vasculitis

48
Q

What can be done to help functional impairment in RA?

A 
Special adaptive cutlery
Special footwear
Walking aids
Use of wheelchair
Supportive family
Care package

MSK (17 decks)

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