Rheumatoid Arthritis Flashcards
What is Rheumatoid arthritis?
Inflammatory arthritis that can affect multiple joints
What is the typical presentation of RA?
- swollen, painful joints in hands and feet
- stiffness worse in the morning
- gradually gets worse with larger joints becoming involved
- presentation usually insidiously develops over a few months
- positive ‘squeeze test’ - discomfort on squeezing across the metacarpal or metatarsal joints
How good is anti-cyclic citrullinate peptide antibody?
It has a sensitivity similar to rheumatoid factor (around 70%) with a much higher specificity of 90-95%.
What is needed for a diagnosis of rheumatoid arthritis?
American College of Rheumatology criteria:
Classification criteria for rheumatoid arthritis (add score of categories A-D;
a score of 6/10 is needed definite rheumatoid arthritis)
What is considered in the american college of rheumatology criteria?
A: Joint involvement
>More joints higher score
B: Serology (RF and ACPA)
>More positive titres higher score
C: CRP & ESR
>Higher score with abnormal results
D: Duration of symptoms
>Higher score for longer time
What deformities develop in RA in the hands?
- Swan neck
* Boutonniere deformities
What is the management of RA? Consider:
>Initial
>Flares
Initial therapy:
*DMARD monotherapy +/- a short-course of bridging prednisolone.
Flares:
*flares of RA are often managed with corticosteroids - oral or intramuscular
What is the most widely used DMARD for RA?
Methotrexate
What medications can be used for RA?
DMARDs:
- 1st Methotrexate
- Sulfasalazine
- Hydroxychloroquine
TNF Inhibitors = if inadequate response to at least 2 DMARDs
*Etanercept
What monitoring should be done when someone is on methotrexate for RA? Why?
Monitoring of FBC & LFTs is essential due to the risk of myelosuppression and liver cirrhosis.
What monitoring is done of RA to assess the response to treatment?
CRP and disease activity (using a composite score such as DAS28) to assess response to treatment
