Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

autoimmune condition that causes chronic inflammation of the synovial joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the presentation of Rheumatoid arthritis?

A
  • symmetrical distal polyarthropathy
  • more common in women
  1. swollen painful joints in hands and feet (MCP, PIP joints typically)
  2. stiffness in am, improves with use
  3. gradually worsening with larger joint involvement
  4. presentation insidious, can have systemic upset
  5. postitive squeeze test - discomfort on squeexing across the metatarsal and metacarpal joints

swan neck and bouttaneire’s deformity - late signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the systemic features associated with RA?

A

Fatigue
weight loss
flu like illness
muscle aches and weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Palindromic Rheumatism?

What is the prognosis?

A
  • relapsing/remitting monoarthritis of a few large joints
  • resolves on its own after 1-2 days
  • RF and anti-CCP +ve may indicate progressing to full RA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What antibodies are present in RA?

what are the NICE guidelines for testing?

A

RF antibodies

  • (usually IgM) present in 70-80%,
  • Targets Fc portion portion of patients own IgG
  • best test is Rose-Waaler test
  • higher titres = more severe disease

Anti-cyclic citrullinated peptide antibody (Anti-CCP)

  • more sensitive and specific than RF
  • can be detected up to 10 years before RA onset

NICE: Test RF negative for anti-CCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which joints are commonly affected with RA

A
  • PIP
  • MCP
  • wrists and ankles
  • cervical spine - atlantoaxial subluxation can cause spinal cord compression
  • large joints later disease - knee, hips, shoulders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can atlatoxial subluxation lead to?

A

can lead to spinal cord compression - emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs in the hands seen in RA?

A
  1. boggy feeling around joints on palptation (due to inflamamation and swelling)
  2. Z-shaped deformity of the thumb
  3. Swan neck deformity (hyperextended PIP with flexed DIP)
  4. Boutonnieres deformity (hyperextended DIP with flexed PIP)
  5. Ulnar deviation of the fingers at the knuckle (MCP joints)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are extra-articular manifestations of RA?

A
  1. RESP: Pulmonary fibrosis, effusion and nodules, Bronchiolitis Obliteran
  2. EYES: Keratonconjunctivitis sicca ,Episcleritis, scleritis, corneal ulceration, keratitis
  3. HEART: pericardial effusion, pericarditis, IHD
  4. Felty’s syndrome (RA, Neutropenia, splenomegaly)
  5. Secondary Sjogren’s
  6. Carpel Tunnel
  7. Amyloidosis
  8. Anaemia of chronic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What investigations would you do for RA?

A
  • RF
  • Anti-CCP (if RF negative)
    Inflammatory markers: ESR , - CRP
  • X-ray of hands and feet
  • USS of joints - to evaluate and confirm synovitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are X-ray changes seen in RA?

A
  1. soft tissue swelling
  2. Loss of joint space
  3. Juxta-articular oesteopenia/osteoporosis
  4. Bony erosions and subluxation - later stage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is RA diagnosed?

A

NICE recommends clinical diagnosis more important

Criteria from american college
scored on:
1. Joint involvement (more and smaller joints score higher)
2. Serology (RF, Anti-CCP)
3. Inflammatory markers - ESR, CRP
4. duration of symptoms (more or less than 6 weeks)

> = 6 –> RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is disease activity monitored in RA?

A

DAS28 - disease activity score

  • based on assessment of 28 joints
  • points given for swollen joints, tender joints and ESR/CRP

Treatment should be escalated until control is reached (Treat to target)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is RA managed?

What do the biologics carry a risk of?

A
  • Initial therapy: DMARD (methotrexate, leflunomide, sulfasalazine, hydroxychlorquinone)
    +/- short course of bridging prednisolone (starting earlier has better prognosis)
  • Flares: Steroids - oral or IM
  • Symptomatic relief: NSAIDs
  • Specialist physio, surgery (manage deformities)

Biologics are alternatives to DMARDs if patient unresponsive to 2 different ones:

  1. TNF-alpha inhbitors - Adalimumab, Infliximab, etanercept
  2. Ritixumab (Anti-CD20, results in B cell depletion)

All immunosuppressant -
Infections
reactivation of dormant infections e.g TB, Hep B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the escalation of drug management in RA?

A

1st line: DMARD. hydroxychloroquinone for mild

2nd line: combination of DMARD

3rd line: Methotrexate + biologic (usually TNF-alpha inhibitor

4th Line: Methotrexate + rituximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the drug side effects of Methotrexate?

A

Myelosuppression
Liver cirrhosis
Pneuomonitis/pulmonary fibrosis
teratogenic

17
Q

What is the side effect of Sulfasalazine?

A

Rashes
Temporary male infertility
Bone marrow suppresion

18
Q

What are the side effects of Leflunomide

A
  • Hypertension
  • Interstitial lung disease
  • Liver impairment
19
Q

What are the side effects of Hydroxychloroquine

A

anti-malarial

  • retinopathy, corneal deposits
  • Liver toxicity
20
Q

Side effects of Anti-TNFalpha drugs

A

Adalimumab, Infliximab, Etanercept - reactivation of TB

21
Q

Rituximab side effects?

A

Infusion reactions

Rheumatology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions