Rheumatoid arthritis

Question 1

What causes RA?

Answer 1

Autoimmune

Question 2

What is the pathophysiology of RA?

Answer 2

Inflammation and thickening of synovium

Thinning of cartilage

Question 3

What are the risk factors for RA?

Answer 3

Female
FH
50-55yo

Question 4

What are the joint features of RA?

Answer 4

Active symmetric arthritis lasting >6 weeks
Pain, morning stiffness
Swelling- soft, boggy, tender
Deformity- swan neck, ulnar deviation, Z deformity, subluxation

Question 5

What joints are classically affected in RA?

Answer 5

Wrist and MCP

Spared DIP

Question 6

What are the extra-articular features of RA?

Answer 6

ANTI CCP Or RF
Arthritis
Nodules- over MCP and PIP
Tenosynovitis
Immune
Cardiac
Carpal tunnel
Pulmonary
Ophthalmic
Raynaud's
FElty's

Question 7

What is Felty’s?

Answer 7

RA
Splenomegaly
Neutropenia

Question 8

What investigations are done for RA?

Answer 8

Immunology- RF and anti CCP

XR

Question 9

What are the XR findings in RA?

Answer 9

SPADES
Soft tissue swelling
Peri-articular swelling
Absent osteophytes
Deformity
Erosions
Subluxations

Question 10

What are the steps of pharm management of RA?

Answer 10

1. NSAIDs
2. Steroids
3. DMARDs
4. Biologics

Question 11

What are the DMARD options for RA?

Answer 11

Methotrexate
Sulfasalazine
Hydroxychloroquine

Question 12

What are the indications for starting biologics in RA?

Answer 12

After failure of 2 DMARDs, one of which must be methotrexate

Question 13

What are some biologics used for RA?

Answer 13

Anti TNF- infliximab
B cell depleter- rituximab
Interleukins- tocilizumab

Question 14

What is the prognosis for RA?

Answer 14

33% out of work 2 years post diagnosis

Life expectancy shortened by 7 years