Rheumatoid arthritis Flashcards
Does RA affect men more commonly
no
What environmental factors can worsen Ra?
Smoking
Describe RA as a condition
An Autoimmune inflammatory arthritis characterised by symmetrical swelling in multiple joints
How does RA show immunological abnormalities?
Immunological mechanisms normally fighting infection/malignant cells target normal tissue.
T lymphocytes produce cytokines which exacerbate inflammation
Describe the pathology of RA
Synovitis, macrophages and osteoclasts form chronically inflamed tissue (pannus) extending from margins and eroding articular cartilage.
Cartilage and bone erosion lead to deformity
When is the peak incidence of RA?
30-50, insidiously
What will RA patients experience
Pain, swelling, and stiffness which is worse on waking and eases as the day progresses.
Which joints does RA affect
Primarily small ones, MCPs, DIPs, PIP joints
What are the 3 types of deformity that can affect the hand with RA
Ulnar deviation, Boutonniere and swan neck deformity
Recall how RA affects the foot.
Forefoot synovitis. Proximal phalanges sublux dorsally, easily palpated, fat pad protection lost, feeling of walking on marbles,
How does RA affect the cervical spine
Atlantoaxial subluxation - The atlas slips forward on axis reducing space for spinal cord. Can cause neck pain. Odontoid peg may move upwards through the foramen magnum threatening spinal cord and brainstem
Name the subcutaneousnodules found in RA patients, and which RA patients are they more common in
Rheumatoid nodules, rheumatoid factor
What other extra-articular features apart from nodules can RA form?
Tenosynovitis, bursitis, carpal tunnel syndrome
What are the systemic symptoms of RA
Low-grade fever, weight loss lethargy and fatique.
WHat is felty syndrome
Associate of RA, with splenomegaly (Big spleen) and leukopenia. Can lead to frequent infection
What fdo the blood tests for RA show
ESR and CRP raised. Can have rheumatoid factor but anti-CCP more specific
What are the four main radiological signs of rheumatoid arthrits
Soft tissue swelling
Periarticular osteoporosis
Juxta-articular erosion
Narrowing of joint space
WHat impact do NSAIDs have in treating RA?
They can improve joint pain/stiffness but dont affect disease activity/progression
What does NSAID stand for
Non-steroidal anti-inflammatory drug
What does DMARD stand for
Disease-modifying anti-rheumatic drug.
What impact do DMARDs have in treating RA
They supress inflammation and slow progression of erosive joint disease.
Why are corticosteroids given and when
To quickly improve pain and swelling in conjunction with DMARDs because they take time to work.
Which family of drugs to treat RA are very effective but very expensive?
Biologics such as anti-TNF alpha
What are the 5 dmards you need to know
Methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, and gold
What role does the rheumatologist play in the MDT
Monitoring disease activity, prescription and monitoring drug therapy, managing complications, referral, coordination of team and diagnosis
What role does the specialist nurse play in the MDT
Patient education, DMARD monitoring, biologic administration and advice, joint injections
What role does the orthopaedic surgeon play
Replaced damaged joints, surgical synovectomy and tendon repairs
What role do physiotherapists play
Use physical therapies against inflammation, exercises to improve strength and ROM
What role do occupational therapists play
Splint acutely inflamed joints, advise on how to minimise joint stressin life, apparatus to assist with daily living
What role do podiatrists play
Assessment of footwear and advice on choosing suitable shoes. Custom insoles
