Rheumatoid Arthritis

Question 1

Define rheumatology

Answer 1

Medical specialty that deals with investigation, diagnosis + management of patients with arthritis + related conditions. Incorporates > 200 disease including inflammatory arthritis, connective tissue disease + bone disease

Question 2

What is rheumatoid arthritis

Answer 2

RA is a chronic, autoimmune, systemic illness characterised by symmetrical peripheral arthritis and other systemic features. Is one of the commonest chronic illnesses and is associated with joint damage, disability and premature disability.

Question 3

Define rheumatoid synovitis

Answer 3

Rheumatoid synovitis (pannus) characterised by inflammatory cell infiltration, synoviocyte proliferation and neoangiogenesis. Synovial fluid in joint cavity contains neutrophils especially during acute flares of RA. Synovial pannus causes bone and cartilage destruction.

Question 4

Describe the prevalence of RA

Answer 4

Approximately 1% of the population (i.e. approx. 4000 cases in Grampian (40,000 cases in Scotland)

Question 5

What are the signs and symptoms of rheumatoid arthritis?

Answer 5

Symptoms: pain, stiffness, swelling, functional impairment, systemic symptoms.
Signs: tenderness and swelling, restriction of movement, heat and redness, systemic features.

Question 6

What are aetiological factors of RA?

Answer 6

Genetic factors, cigarette smoking, chronic infection e.g. periodontal disease

Question 7

How is RA diagnosed?

Answer 7

Immunology:

• Rheumatoid factor (IgG, IgM)
• Anti-cyclic Citrullinated Antibodies (anti CCP/ACPA) -> greater specificity

X-ray (changes in advanced stage)
MRI scan

Question 8

What are systemic manifestations of RA? (non-specific, specific, long term)

Answer 8

Non-specific: fatigue, weight loss, anaemia
Specific – eyes, lungs, nerves, skin, kidneys
Long term – CVS, malignancy

Question 9

What are the different categories of pharmacological intervention for arthritis?

Answer 9

Disease modifying anti-rheumatic drugs (DMARDs). Biologics (target inflammatory stages, work rapidly, well tolerated). NSAIDS. Corticosteroids (IM, IA, oral; for pain relief; short term relief, long term toxicity). Pain relief.

Question 10

What are the disease modifying anti-rheumatic drugs (DMARDs)?

Answer 10

METHOTREXATE. Sulfasalazine. Leflunomide. Hydroxychloroquine.

Question 11

What are the biologics drugs?

Answer 11

Infliximab. Adalimumab. Rituximab. Combination w/ methotrexate.

Question 12

What corticosteroids are used?

Answer 12

Prednisolone. Prednisone.

Question 13

What is used for pain relief?

Answer 13

Paracetamol. NSAIDS.

Question 14

What score is used to assess RA disease severity?

Answer 14

Disease activity score