Rheumatoid arthritis

Question 1

what type of disease is rheumatoid arthritis(RA)

Answer 1

autoimmune chronic inflammatory

Question 2

when does rheumatoid arthritis typically present

Answer 2

in the 2nd to 4th decades

Question 3

describe the proportion of females to males in rheumatoid arthritis

Answer 3

3 female: 1male

Question 4

describe the general systemic features of rheumatoid arthritis

Answer 4

malaise, fever and generalised musculo-skeletal pain

Question 5

describe the effect that rheumatoid arthritis has on the joints

Answer 5

swollen, warm, painful, limited movement in morning and after inactivity

Question 6

what joints are usually effected by rheumatoid arthritis

Answer 6

small joints before large joints

hands and feet, then wrists , ankles, elbows, knees, cervical spine

Question 7

what joints are usually spared in rheumatoid arthritis

Answer 7

hips and lumbosacral joints

Question 8

describe some features of rheumatoid arthritis progression

Answer 8

joint fusion(ankylosis), limited ROM, synovial herniation, joint effusions, loss of articular cartilage

Question 9

describe the genetic factors linked to rheumatoid arthritis(RA)

Answer 9

HLA DR4 mediated

Question 10

describe some environmental factors linked to rheumatoid arthritis(RA)

Answer 10

precise trigger uncertain, infection and cigarette smoking involved

Question 11

what is found in 80% of RA patients

Answer 11

rheumatoid factor, an IgM or IgA autoantibody that binds Fc region of IgG

Question 12

describe the histological changes seen in the acute phases of rheumatoid arthritis

Answer 12

pannus formation= inflammatory granulation tissue

hyperplastic/reactive synovium

Question 13

describe the effect of rheumatoid arthritis on the cartilage of the joints

Answer 13

cartilage is destroyed by inflammatory process and results in loss of joint space

Question 14

describe the changes seen in chronic RA

Answer 14

fibrosis and deformity

Question 15

what % of RA patients have extra-articular manifestations

Answer 15

40%

Question 16

give some examples of RA extra-articular manifestation

Answer 16

rheumatoid nodules on skin(25%), salivary gland swelling, endocarditis, anaemia
(many more)

Question 17

describe the pattern of the joints that are affected by RA

Answer 17

symmetrical

Question 18

if untreated what can RA lead to

Answer 18

joint damage irreversible deformities leading to loss of function and increased morbidity and mortality

Question 19

what is the main structure in the joints affected by RA

Answer 19

the synovium

Question 20

what investigations are used in rheumatoid arthritis

Answer 20

blood tests, inflammatory markers, imaging(eg X-ray), autoantibodies

Question 21

what blood tests are done in RA

Answer 21

testing anaemia of chronic disease and raised platelets

Question 22

what inflammatory markers are seen in RA

Answer 22

raised CRP, raised ESR, plasma viscocity

Question 23

what factors are taken into account in the classification of RA

Answer 23

joint distribution, serology, symptom duration, acute phase reactants

Question 24

describe the clinical features of RA

Answer 24

prolonged morning stiffness(>30mins), involvement small joints hands + feet, symmetric distribution, positive compression tests for MCP and MTP joints

Question 25

what are some of the clinical presentations of RA

Answer 25

synovitis in small joints(main), poor grip strength, monoarthritis, tenosynovitis, trigger finger, carpal tunnel syndrome

Question 26

what autoantibodies are seen in RA

Answer 26

rheumatoid factor and antibodies to cyclic citrullinated peptide(anti-CCP)
(only around 70% RA patients sensitive to these)

Question 27

describe the relevance of anti-CCP antibodies in RA

Answer 27

can be present prior to symptoms, associated with cigarette smoking, associated with erosive damage, can be -ve and still have RA

Question 28

what imaging is used in RA

Answer 28

always plain X-ray of hands + feet, sometimes ultrasound scanning(better in early disease), MRI scans

Question 29

what score is used to calculate disease activity in RA, and what does it take into account

Answer 29

DAS-28

28 different joints(not feet), if they are swollen or tender, raised ESR and CRP

Question 30

what is early RA defined as

Answer 30

defined as less than 2 years since symptom onset

Question 31

give some examples of complications of untreated RA in the hands

Answer 31

boutonniere deformity of thumb, ulnar deviation MCP joints, swan-neck deformity of fingers

Question 32

give some examples of complications of untreated RA in the feet

Answer 32

MCP joints have conns formed over them, may ulcerate, osteoarthritis, hallux valgus, forefoot widening, would complain walking on pebbles/marbles

Question 33

are DIP(distal interpharangeal) joints involved in rheumatoid arthritis

Answer 33

no they are spared