Rheumatoid Arthritis

Question 1

what genes are linked to RA

Answer 1

HLA DR1 and DR4

Question 2

antibodies in RA

Answer 2

anti CPP and RF

Question 3

what cells make anti CPP and RF

Answer 3

B cells

Question 4

where do you get nodules in RA

Answer 4

joints (esp elbows, fingers and feet and heel)

lungs

Question 5

what is de quervain’s tenosynovitis

Answer 5

irritation of the tendon sheath on the lateral wrist. caused by repetitive thumb movement

Question 6

true/false - RA is associated with carpal tunnel syndrome

Answer 6

true

Question 7

lung presentations of RA

Answer 7

pleural effusions
nodules
fibrosing alveolitis

Question 8

what are the nodules like in RA

Answer 8

firm, nont-tender, mobile or fixed

Question 9

cardiac presentations of RA

Answer 9

pericardititis and pericardial effusion

Question 10

diagnostic criteria for RA

Answer 10

4 out of the following 7

• morning stiffness >6 weeks
• arthritis in >3 joints
• arthritis of hand
• symmetrical
• rheumatoid nodules
• +ve RF
• radiographic changes

Question 11

when is RA worst

Answer 11

in the morning. takes >1 hour to warm up

Question 12

what bloods will be raised in RA

Answer 12

ESR, CRP and platelets

Question 13

what is the most specific RA antibody

Answer 13

anti CCP

Question 14

if the RF is -ve. what broadly is the diagnosis

Answer 14

seronegative rheumatoid arthritis

Question 15

investigations for RA

Answer 15

FBC
RF, anti CCP and ANA serology
x-ray, US and MRI

Question 16

what score is used to monitor disease activity

Answer 16

DAS28

Question 17

two types of RA drugs

Answer 17

DMARDs and biologics

Question 18

methotrexate, sulfasalzine and hydroxychloroquine are what type of drug

Answer 18

DMARDs

Question 19

how do most DMARDs work

Answer 19

by immunosuppresion

Question 20

what is the 1st line treatment in RA

Answer 20

DMARDs

Question 21

give 3 examples of biologics

Answer 21

infliximab, adalimumab and ritixumab

Question 22

what is the main mechanism of these commonnly used biologics

Answer 22

anti-TNFa

Question 23

which biologic isn’t anti TNFa and so is used when those ones don’t work

Answer 23

rituximab - anti-CD20

Question 24

what cells express CD20

Answer 24

mature b cells

Question 25

adverse effects of methotrexate

Answer 25

hepatotoxiciy and pulmonary fibrosis

Question 26

side effect of all DMARDs

Answer 26

pancytopenia - from myelosuppression

Question 27

treatment options in RA

Answer 27

DMARDs
biologics
steroids (IM or IA)
NSAIDs
regular exercise
PT and OT
aids and splints
surgery

Question 28

what is the prognosis of RA

Answer 28

1/3rd will stop working in 2 years

Question 29

what is the peak age of RA

Answer 29

4th and 5th decade