Rheumatoid arthritis Flashcards
Poor prognostic signs in RA
Age >60 at diagnosis
RF positive
Delay in dx and treatment
How do most people present w RA
fatigue, anorexia, non specific MSK pains
Very few presents with severe arthritis
Presentation of RA
Dx and prognostic features Presenting features Initial treatment Disease progression - joints involved Alteration in treatment overtime Complications of treatment Non articular features of RA Drug cx Current major problem Current disease activity
Non articular features of RA
Skin - raynaud's, leg ulcers Eyes - dry eyes, cataracts, scleritis Sore throat Lungs - ILD, pleuritis Heart - pericarditis, valve disease, atherosclerosis Renal - drug use amyloid CNS toxicity Nodules Blood - anaemia, felty's Systemic - fever, weight loss, fatigue vasculitis
Treatment SE of methotrexate
haematological
hepatic toxicity
pulmonary
treatment SE if hydroxychloroquine
nausea, pigmentation, bull’s eye retinopathy
treatment SE of sulfasalazine
rash, nausea, haematological abnormalities, abnormal liver function, reversible oligospermia
Rheumatoid arthritis examination
- ax joint synovitis
- Hand function
- steroid coplications
- Sx of sjogren’s syndrome
- Chest - pericarditis, valvular disease, pulmonary fibrosis
- Abdo - splenomegaly
- Hips and knees
- Peripheral nervous system
- Skin - cutaneous vasculitis
Ddx for symmetrical chronic polyarthropathy
RA Psoariatic arthropathy Seronegative spondyloarthropathies Chronic tophaceous gout Primary generalsied OA SLE
What investigations to review for RA
RF, CCP
XR films of involved joints
ESR.CRP
What XR features of rheumatoid arthritis are there
soft tissue swelling
symmetrical joint space narrowing (cf OA which is asymmetrical narrowing) and erosins
juxtaarticular osteoporosis
marginal joint erosions
Differentials for increased ESR/CRP in rheumatoid arthritis
active disease
amyloidosis
infection
sjogren’s syndrome
Investigations to assess for activity in rheumatoid arthritis
ESR/CRP
Normocytic anaemia
Anti CCP, RF titres
Presence of progressive erosions on serial X-ray films
Principles of treatment of rheumatoid arthritis
Education Physiotherapy Occupational therapy Smoking cessation Rest of inflammed joints Pharmacology are reducing pain and inflammation and preventing progression of disease
Indications for steroids in rheumatoid arthritis
bridge to suppressive therapy w DMARD
high dose to treat vasculitic complications
chronic low dose therapy in elderly
