Rheumatoid arthritis Flashcards
Features
swollen, painful joints in hands and feet
stiffness worse in the morning
gradually gets worse with larger joints becoming involved
presentation usually insidiously develops over a few months
positive ‘squeeze test’ - discomfort on squeezing across the metacarpal or metatarsal joints
Systemic disturbance
Are swan neck and boutonniere deformities later or early features
Late
Flares of RA are treated with what ?
Corticosteroids- Oral or IM
Most widely used DMARD
Methotrexate
Adverse effects of methotrexate
mucositis myelosuppression pneumonitis pulmonary fibrosis liver fibrosis
DMARDs
Methotrexate
Sulfasalazine
Leflunomide
Hydroxychloroquine
Initial therapy
They now recommend DMARD monotherapy +/- a short-course of bridging prednisolone. In the past dual DMARD therapy was advocated as the initial step.
Other drugs
TNF- inhibitors
Rituximab
Abatacept
RF antibodies
- RF
- Anti- cyclic citrullinated peptide antibody
Poor prognostic features
prognostic features rheumatoid factor positive poor functional status at presentation HLA DR4 X-ray: early erosions (e.g. after < 2 years) extra articular features e.g. nodules insidious onset anti-CCP antibodies
Rheumatoid arthritis: x-ray changes
loss of joint space juxta-articular osteoporosis soft-tissue swelling periarticular erosions subluxation
Complications of RA
Respiratory: pulmonary fibrosis, pleural effusion, pulmonary nodules, bronchiolitis obliterans, methotrexate pneumonitis, pleurisy .
Osteoporosis
Ischaemic heart disease
Depression
Episcleritis, scleritis, corneal ulceration, keratitis, chloroquine retinopathy
Felty’s syndrome features as a complication of RA
RA, splenomegaly and low white cell count
