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Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is RA?

A
  • Autoimmune condition which causes chronic inflammation of synovial lining of joints
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2
Q

What is the pattern of joint manifestation in RA?

*dont include sx. focus more on distribution of disease

A
  • At least 6 weeks
  • At least 3 joints
  • Symmetrical
  • hands- PIPJ, MCPJ
  • worse in morning - gets better after activity
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3
Q

Why the DIPJ not typically affected in RA?

A
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4
Q

What genes are involved in RA?

A
  • HLA DR4
  • HLA DR1
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5
Q

What are the RF for RA?

A
  • F
  • Smoker
  • Middle age - but can occur in any age
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6
Q

What are RA pt at risk of developing?

A

cardiovascular disease

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7
Q

What is the Px of RA?

A
  1. Rheumatoid Factor RF (which is an IgM) targets Fc portion of IgG
  2. Activation of systemic immune system against pt own IgG
    3.
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8
Q

What are the Sx for RA?

A
  • Symmetrical, swollen, painful, stiff small joints of hands and feet
  • worse in morning

Less common

  • Sudden onset widespread arthritis
  • Recurring mono/polyarthritis
  • persistent monoarthitis
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9
Q

What are the signs of RA?

A
  • Early
    • swollen MCP, PIP, wirst, MTP joints
    • tenosynovitis
    • bursitis
  • Late
    • Ulnar deviation & sublaxation of wrist and fingers
    • Boutonniere deformity
    • Swan neck deformity
    • Z-deformity of thumb
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10
Q

What are the extra-articular signs of of RA?

A
  • Systemic
    • fever, weight loss, fatigue
  • Eyes
    • Episcleritis, scleritis
  • Lungs
    • Interstitial fibrosis, pleural disease, bronchiolitis obliterans
  • Heart
    • pericarditis, IHD, pericardial effusion
  • MSK
    • rheumatoid nodules, Carpal Tunnel Syndrome
  • Felty’s syndrome
    *
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11
Q

What is Palindromic Rheumatism?

A
  • short episodes of inflammatory arthritis
  • last for 1-2days - resolves after
  • if RF and anti-cpp + > will prgress to full RA
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12
Q

Where is Heberden’s nodes typically seen in?

A

OA

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13
Q

What is Boutenniere’s deformity?

A
  • hyperextended DIP
  • flexed PIP
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14
Q

What is swan neck deformity?

A
  • hyperextended PIP
  • flexed DIP
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15
Q
A
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16
Q

What is Felty’s syndrome?

*rememebr SANTA

A
  • Splenomegaly
  • Anaemia
  • Neutropenia
  • Thrombocytopenia
  • Arthritis
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17
Q

What ix would you order for RA?

A

*RA is clinically diagnose

Bloods

  • RF
  • anti-CCP (very specific 98%)
  • infalmmatory markers

Imaging

  • bilatera xray of hands, feet
18
Q

What are the hallmark signs of RA on xray?

*remember LESS

A
  • Loss joint space
  • Erosions
  • Soft tissue swelling
  • Soft bone (osteopenia)
19
Q

What are patiets scored on for RA?

What is the cut off point?

A
  • Joints involved (more and smaller score higher)
  • Serology (RF & anti-CPP)
  • Infalmmatory markers (ESR, CRP)
  • Duration of Sx (more or less than 6 weeks)
20
Q

What type of questionnaire is used to check response to tx?

A

Health Assessment Questionnaire (HAQ)

21
Q

What are the criterias to refer pt for specialist review?

A
  • Any adult with persistent synovitis - even with neg RF and aCCP
  • Urgent if
    • small joints of hands and feet involved
    • multiple joints
    • sx persist for 3months
22
Q

How would you Mx RA?

A
  • Sx relieve
    • steroids
    • NSAIDs
  • Disease Modifying AntiRheumatic Drug (DMARD)
  • Biological Therapies
  • Surgery
23
Q

What is the NICE guidelines for DMARD?

A
  • First line
    • Hydoxychloroquin - most mild
    • Methotrexate
    • Leflunomide
    • Sulfasalazine
  • Second line
    • use 2 from above
  • Third line
    • Methotrexate + TNF inh.
24
Q

What are the examples of biological therapies?

A
  • Anti TNF
    • adalimumab
    • infliximab
    • entanercept
  • Anti CD20
    • rituximab
25
Q

What is the MOA of Methotrexate?

A
  • Inh. dihydrofolate reductase > decrease folate production
26
Q

What is the dose for Methotrexate and what supplement is co-prescribed with it?

A
  • 2.5mg once weekly
  • Folic acid 5mg once weekly
27
Q

What are the Side efects for methotrexate?

A
  • Pulmonary Fibrosis
  • Teratogenic
  • Myelosuppressive
28
Q

What is the MOA of Sulfasalazine?

A
  • Unclear. Act as immunosuppresion
  • Safe in pregnancy
29
Q

What are the side effects of Sulfasalazine?

A
  • Myelosuppresion
  • Temporary male infertility
30
Q

What is the MOA of leflunomide?

A
  1. inh. mitochondrial enzyme DODH
  2. Prevent pyrimidine production
31
Q

What are the side effects of leflunomide?

A
  • Peripheral neuropathy
  • teratogenic
  • liver toxicity
  • myelosuppresion
32
Q

What is the MOA of hydroxychloroquin?

A
  • Blocks Toll-like receptors
  • disrupt antigen presenting
  • increase pH in lysosome of immune cells

Safe in pregnancy

33
Q
A
34
Q

What are the s.e. of Hydroxychloroquin?

A
  • Night mares
  • macular toxicity
  • liver toxicity
  • skin pigmentation
35
Q

What is the MOA of anti TNF?

A
  1. monoclonal antibodies targeting TNF
  2. prevent inflammation from occuring
36
Q

What are the s.e. of anti TNF

A
  • reactivation of latent TB, Hep B
  • vulnerable to severe infection and sepsis
37
Q

What are the s.e. of Rituximab?

A
  • night sweats
  • thrombocytopenia
38
Q

What is the histological appearance of subcutaneous nodules in RA?

A
  • Fibrinoid necrosis surrounded by palisading epitheloid cells
39
Q

What will be the annual primacy care review for RA?

A
  1. Assess for flares
  2. Ensure pt knows how to access specialist help
  3. Drug monitoring
  4. Assess disease activity
  5. Use QRISK and FRAX and other tools to assess comorbidities
  6. Smoking cessation, exercise, healthy diet
  7. Offer vaccinations (pneumococcal and influenza)
40
Q

What are the adverse effects of Sulfasalazine?

A
  • oligospermia (will be back to normal if drug is stoppd`)
  • Stevens-Johnson syndrome
  • pneumonitis / lung fibrosis
  • myelosuppression, Heinz body anaemia, megaloblastic anaemia
  • may colour tears → stained contact lenses
41
Q

What are the contraception and pregnancy advice for pt on methotrexate?

A
  • women should avoid pregnancy for at least 6 months after treatment has stopped
  • the BNF also advises that men using methotrexate need to use effective contraception for at least 6 months after treatment
42
Q

What medications would you use when RA pt have flares?

A
  • corticosteroid PO or IM

Rheumatology (15 decks)

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