Rheumatoid Arthritis

Question 1

What is rheumatoid arthritis (RA)? (4)

Answer 1

Chronic, systemic, autoimmune disorder causing symmetrical polyarthritis

Question 2

What are the risk factors for RA? (3)

Answer 2

Genetics (HLA DR4, DR1)
Smoking
Female

Question 3

What are the symptoms of RA? (4)

Answer 3

Symmetrical, swollen painful and stiff joints (WORSE in MORNING)
Morning stiffness > 30mins
Pain relieved w activity + NSAIDs
Systemic: fatigue, fever, pericarditis

Question 4

What are the early signs of RA? (2)

Answer 4

Synovitis

Swollen MCP, PIP, wrist, MTP joints

Question 5

What are the late signs of RA? (3)

Answer 5

Ulnar deviation
Boutonniere deformity
Swan neck/ Z-thumb

Question 6

How would you investigate RA?

Answer 6

Bloods: raised CRP, ESR, rheumatoid factor
Anti-cyclic citrullinated peptide (anti-CCP) = GS!
X-ray: LESS

Question 7

What would you see on an x-ray of a RA pt? (4)

Answer 7

Loss of joint space
Erosion periarticular)
Soft tissue swelling
Soft bones (osteopenia)

Question 8

How would you treat RA? (5)

Answer 8

DMARDS: methotrexate, sulfasalazine
Steroids: IM methylprednisolone
NSAIDs: ibuprofen/ aspirin
Physio + occupational therapy
Manage risk factors: stop smoking, exercise, wt loss