Rheumatoid Arthritis

Question 1

P

Answer 1

Chronic inflammation of synovial joints

Symmetrical deforming peripheral arthritis

Question 2

A

Answer 2

20-40
Female
FHx
Gneetics
Smoking

Question 3

CF

Answer 3

Stiffness in the morning > 1 hour
Symmetrical joint pain
Swollen joints
Small joints of hand, feet and wrist
Worse in morning

Ulnar deviation and sublaxation of wrist and fingers
Boutonnieres deformity - flexion of PIPJ, extension of DIPJ
Swan neck deformity - extension of PIPJ, flexion of DIPJ
Z thumb - hyperextension of IPJ and flexion of MCP joint

Question 4

Extra-articular manifestations

Answer 4

Nodules on elbows, lungs, cardiac, CNS< lymphadenopathy
Pleural disease, interstitial fibrosis
IHD, pericarditiis, pericaridal effusion, CTS,
Peripheral neuroapthy
Scleritis
Keratoconjunctivitis sicca
Osteoporosis

Question 5

RA vs OA

Answer 5

RA symmaterical OA asymmterica
RA morning stiffness >1h, OA < 30m
OA worse on movmemnt
RA 20-40 OA >50
OA slower onset
RA systemic symptoms
RA worse in morning
OA worse at end of day

Question 6

Ix

Answer 6

BLoods:
RF
Anti-CCP - highly specific
FBC - anaemia of chornic disease, 
ESR
CRP

X-ray
Loss of joint space
Justa-articular Osteopenia
Soft tissue swelling
Sublaxation, erosions

Question 7

Diagnosis

Answer 7

Joint involvement
Serology - RF and anti-CCP
Acute phase reactants - ESR and CRP
Duration of sx >6w

Question 8

Mx

Answer 8

Refer to rheum
Exercise, smoking cesation, MDT, physiotherapy

DMARD:
Methotrexate, sulfasalazine, hydroxychloroquine

Methotrexate:
Pneumonitis, oral ulcers, hepatotoxicity, teratogenic
Sulfasalxine
RAshe, oral ulcer, GI upset
Hydroxychloroquine
Retinopathy

Steroids - IM, IA, oral

NSAIDs for symptom relief

TNFalpha
Inflximab

B cell blocker
Rituximab

Question 9

Monitoring

Answer 9

DAS28 and CRP