Rheumatoid Arthritis Flashcards
what genes are linked to RA
HLA DR1 and DR4
antibodies in RA
anti CPP and RF
what cells make anti CPP and RF
B cells
where do you get nodules in RA
joints (esp elbows, fingers and feet and heel)
lungs
what is de quervain’s tenosynovitis
irritation of the tendon sheath on the lateral wrist. caused by repetitive thumb movement
true/false - RA is associated with carpal tunnel syndrome
true
lung presentations of RA
pleural effusions
nodules
fibrosing alveolitis
what are the nodules like in RA
firm, nont-tender, mobile or fixed
cardiac presentations of RA
pericardititis and pericardial effusion
diagnostic criteria for RA
4 out of the following 7
- morning stiffness >6 weeks
- arthritis in >3 joints
- arthritis of hand
- symmetrical
- rheumatoid nodules
- +ve RF
- radiographic changes
when is RA worst
in the morning. takes >1 hour to warm up
what bloods will be raised in RA
ESR, CRP and platelets
what is the most specific RA antibody
anti CCP
if the RF is -ve. what broadly is the diagnosis
seronegative rheumatoid arthritis
investigations for RA
FBC
RF, anti CCP and ANA serology
x-ray, US and MRI
what score is used to monitor disease activity
DAS28
two types of RA drugs
DMARDs and biologics
methotrexate, sulfasalzine and hydroxychloroquine are what type of drug
DMARDs
how do most DMARDs work
by immunosuppresion
what is the 1st line treatment in RA
DMARDs
give 3 examples of biologics
infliximab, adalimumab and ritixumab
what is the main mechanism of these commonnly used biologics
anti-TNFa
which biologic isn’t anti TNFa and so is used when those ones don’t work
rituximab - anti-CD20
what cells express CD20
mature b cells
adverse effects of methotrexate
hepatotoxiciy and pulmonary fibrosis
side effect of all DMARDs
pancytopenia - from myelosuppression
treatment options in RA
DMARDs biologics steroids (IM or IA) NSAIDs regular exercise PT and OT aids and splints surgery
what is the prognosis of RA
1/3rd will stop working in 2 years
what is the peak age of RA
4th and 5th decade
