Rheumatoid Arthritis

Question 1

Rheumatoid Arthritis Definition

Answer 1

• Chronic inflammatory autoimmune disease leading to inflammation of the synovial joints leading to joint and periarticular tissue destruction
• Extra-articular features

Question 2

Rheumatoid Arthritis Epidemiology

Answer 2

• Greater in women

- Peak incidence in 40s

Question 3

Rheumatoid Arthritis RFs

Answer 3

• Interaction between genetic susceptibility and environmental factors
• Smoking
• HLA DR4 and DR1 associated

Question 4

Rheumatoid Arthritis Presentation

Answer 4

• Insidious, bilateral, symmetrical polyarthritis with non-specific symptoms
• More joints affected with progression
• Heat, redness, swelling, pain, stiffness (especially in morning or after inactivity)
• Small joints, wrist, ankle, knee, cervical spine
• Ulnar deviation, swan neck, Boutonnière’s, Z-thumb, piano key

Question 5

Rheumatoid Arthritis Systemic Signs

Answer 5

• Eyes: secondary Sjögren’s, scleritis, episcleritis
• Skin: leg ulcers (especially in Felty’s)
• Rheumatoid nodules
• Pulmonary fibrosis
• Pericardial involvement

Question 6

Rheumatoid Arthritis Differentials

Answer 6

• Viral arthritis
• Reactive arthritis
• Seronegative spondyloarthropathy (AS, IBD)
• SLE
• PMR

Question 7

Rheumatoid Arthritis Investigations

Answer 7

• Diagnosis is clinical
• RF, anti-CCP
• X-rays

Question 8

Rheumatoid Arthritis Management

Answer 8

• DMARD mono therapy
• If methotrexate cannot be used, leflunomide, hydroxychoroquine, sulfasalazine
• NSAIDs and corticosteroids for symptom control
• Folic acid supplementation
• If methotrexate ineffective, use biological agent
• Steroids if pregnant