Rheumatoid arthritis Flashcards

1
Q

When is the pain worse?

A

In the morning.

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2
Q

What is the pathophysiology of RA?

A

· Inflamed synovium is central to the pathogenesis.

· Synovium shows:

  • Increased angiogenesis.
  • Cellular hyperplasia.
  • Influx of inflammatory cells.
  • Cytokines.

· High levels of metalloproteinase.

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3
Q

What is the aetiology of RA?

A

· Unknown, but thought to involve a type III hypersensitivity reaction.
· Associated with HLA DR4 and HLA DR1.

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4
Q

What risk factors may contribute to a person developing RA?

A

· Genetic predisposition - FHx.

· Smoking.

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5
Q

What hand signs and symptoms may occur?

A
·  Z deformity.
·  Boutonniere deformity.
·  Swan neck deformity.
·  Ulnar deviation.
·  Raynaud's.
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6
Q

What wrist signs and symptoms may occur?

A

Carpal tunnel syndrome.

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7
Q

What feet signs and symptoms may occur?

A

Subluxation of toes and hammer toe deformity.

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8
Q

What skin signs and symptoms may occur?

A

Rheumatoid nodules and vasculitis.

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9
Q

What cardiovascular signs and symptoms may occur?

A

Atherosclerosis is increased in RA.

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10
Q

What respiratory signs and symptoms may occur?

A

Pulmonary fibrosis.

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11
Q

What bone signs and symptoms may occur?

A

Osteoporosis.

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12
Q

What other signs and symptoms may occur?

A

· Pain and swelling.

· Morning stiffness.

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13
Q

What investigations would you request if you suspected a patient had RA?

A

· Bloods.

· X-ray.

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14
Q

What are the typical blood results for RA?

A

· ESR and CRP - raised.

· RF and anti-CCP antibodies - positive.

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15
Q

What would a typical RA x-ray show?

A

Bony erosion, subluxation, carpal instability, joint involvement and osteoporosis.

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16
Q

List some differentials.

A
· Psoriatic arthritis. 
· Infectious arthritis. 
· Gout. 
· SLE.
· OA.
17
Q

What are the 3 management options?

A
  1. Conservative.
  2. Medical.
  3. Surgery.
18
Q

What conservative management options are available?

A

Patient education - exercise, physio.

19
Q

What medical management options are available?

A

· Glucocorticoids.
· DMARDS - Disease modifying anti-rheumatic drugs - such as methotrexate.
· NSAIDs.

20
Q

What surgical management options are available?

A

Arthroplasty or replacement.

21
Q

What treatment option is available for non-pregnant patients?

A

Methotrexate.

22
Q

What complications may occur?

A
· Work disability. 
· Increased joint replacement surgery. 
· Increased CAD. 
· Increased mortality. 
· Carpal tunnel syndrome.