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Junior Medicine- Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A
  • Autoimmune inflammation of synovial joints, tendon sheaths and bursae
  • An inflammatory arthritis
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2
Q

Describe the pattern of joint inflammation.

A

Symmetrical polyarthritis

  • Tends to be symmetrical
  • Affects multiple joints
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3
Q

What complication does tendon inflammation predispose to?

A

Tendon rupture

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4
Q

State the risk factors/associations of RA.

A
  • Family history
  • Female sex (3x)
  • HLA DR4 (in RF positive patients)
  • HLA DR1 (in any RA patient, but not always present)
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5
Q

Which antibodies are used to test for RA?

A
  • Rheumatoid factor (70%), targets Fc portion IgG antibodies

- Anti-CCP (anti-citrullinated cyclic peptide ABs)

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6
Q

What type of antibody is rheumatoid factor?

A
  • Typically an IgM

- But can be any type

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7
Q

Which antibody is more specific to RA?

A

Anti-CCP

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8
Q

Which antibody predates RA in its presence?

A

Anti-CCP

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9
Q

How does RA typically present?

A

Symmetrical distal polyarthropathy

  • Pain (worse in morning)
  • Swelling
  • Stiffness
  • Onset can be rapid i.e. overnight, or months to years
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10
Q

What constitutional symptoms can be present with RA?

A
  • Fever and flu-like illness
  • Weight loss
  • Muscle aches and weakness
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11
Q

What is palindromic rheumatism?

A
  • Self limiting short episodes of inflammatory arthritis
  • Typically only a few joints
  • Lasts 1-2 days and completely resolves
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12
Q

How does palindromic rheumatism relate to RA?

A
  • It can proceed to RA

- Palindromic rheumatism + RF/anti-CCP = progression to RA

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13
Q

Which small joints are commonly affected?

A
  • PIP Joints
  • MCP Joints
  • MTP Joints
  • Wrist and Ankle
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14
Q

Which larger joints are commonly affected ?

A
  • Cervical spine
  • Knees
  • Hips
  • Shoulders
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15
Q

What is atlantoaxial subluxation?

A
  • The shift of the axis and odontoid peg within the atlas
  • Causes local synovitis and spinal cord compression
  • Is an emergency
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16
Q

What signs might you see in the hands?

A
  • Boggy feeling around the hand joints
  • Z shaped deformity to the thumb
  • Swan neck deformity (hyperext PIP, flexed DIP)
  • Boutonnieres deformity (flexed PIP, hyperext DIP0
  • Ulnar deviation at the MCP joints
17
Q

How does Boutonnieres Deformity occur?

A
  • Tear in central slip of extensor components

- When a patient straightens their finger, the flexor digitorum superficialis tendons pull the distal phalanx

18
Q

What are some extra-articular manifestations occur in RA?

A
  • Secondary pulmonary fibrosis (Caplan’s Syndrome)
  • Bronchiolitis obliterans (inflammation causing small airway destruction)
  • Felty’s Syndrome
  • Sicca Syndrome
  • CVS disease and anaemia of chronic disease
  • Rheumatoid nodules
19
Q

What is Felty’s Syndrome?

A

RA, neutropenia, splenomegaly

20
Q

What is Sicca Syndroma?

A

Sjogren’s Syndrome secondary to RA

21
Q

What manifestations may occur in the eye?

A
  • Scleritis
  • Episcleritis
  • Keratitis
  • Keratoconjunctivitis
  • Cataracts (secondary to steroids)
  • Retinopathy (secondary to chloroquine)
22
Q

What bloods should you do for RA?

A
  • RF
  • Anti-CCP antibodies
  • Inflammatory markers (CRP, ESR)
  • Full profile (anaemia)
23
Q

What will a joint XR show?

A
  • Destruction/Deformity
  • Soft tissue swelling
  • Periarticular osteopenia
  • Bone erosions
24
Q

What criteria are used for the diagnosis of RA?

A
  • ACR (American College of Rheumatology)

- ELAR (European League Against Rheumatism)

25
Q

What do ACR/ELAR involve?

A
  • The joints that were involved
  • Serology (RF and anti-CCP)
  • Inflammatory markers (ESR and CRP)
  • Duration of symptoms (more or less than 6 weeks)
26
Q

How is RA’s activity assessed?

A

DAS28- assessment of 28 affected joints, includinging ESR and CRP too

27
Q

What factors may make the prognosis work?

A
  • Younger onset
  • Male
  • More joints/organs affected
  • RF/anti-CCP antibodies present
  • Erosions on XR
28
Q

How are RA flares treated?

A

NSAIDs and PPI protection

29
Q

What medical treatment is used for RA?

A

1- DMARD monotherapy

2- 2 DMARDs together

3- Methotrexate + Biological + TNF inhibitor

4- Methotrexate + Rituximab (anti-CD20)

30
Q

Which DMARDs are used in pregnancy?

A

Hydroxychloroquine and sulfasalazine

31
Q

When is surgery used?

A

Only when joint is deformed to cause functional problems- rarely gets to this stage with DMARDs

32
Q

Which biologicals are important to remember?

A
  • Adalimumab, infliximab, etanercept (anti-TNF)

- Rituximab (anti-CD20)

Junior Medicine- Rheumatology (11 decks)

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