Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis?
- A systemic inflammatory disease
- Symmetrical, deforming, peripheral polyarthritis
What is the typical presentation of RA?
- Symmetrical swollen, painful, stiff small joints of hand and feet
- Worse in the morning >30 minutes
- Fatigue and malaise
- Over 6 week bistory
What are some signs you’d see on examination with a patient with RA?
- Swollen MCPJ, PIP, wrist, MTPJ’s
- Ulnar deviation or subluxation of the wrist and fingers
- Boutonniere’s deformity/Swan neck deformity
- Z deformity of thumb
What are the 3 C’s of extra articular manifestations of RA?
- CVD risk - IHD, pericarditis
- Carpal tunnel syndrome
- Cord compression (atlanto axial subluxation)
What are the 3 P’s of extra articular manifestations of RA?
- Pericarditis
- Pleural disease
- Pulmonary disease - bronchiectasis, bronchiolitis obliterans, fibrosis
What are the 3 A’S of extra articular manifestations of RA?
- Anaemia - normocytic and normochromic
- Amyloidosis
- Arteritis
What are the 3 S’s of extra articular manifestations of RA?
- Sjogren’s
- Scleritis/Episcleritis
- Splenomegaly (with neutropenia is Felty’s syndrome)
What joints does RA usually affect?
- Hand - MCPs, PIPs. Usually spares DIPs
- Feet - MTPs
- Can affect any joint including hips, knees, shoulders, c-spine
What are some hand abnormalities you’d see on examination in a patient with RA?
- Soft tissue swelling and tenderness
- Ulnar deviation of MCPs
- Subluxation of fingers
- Z deformity of the thumb
- Swan neck deformity
- Boutonniere deformity of digits
- Rheumatoid nodules, most common at the elbow
- Carpal tunnel association
What bloods would you undertake in a patient with RA and why?
- RF and anti-CCP (antibodies associated with RA)
- FBC - normocytic, normochromic anaemia. Thrombocytosis.
- WCC - Rule out septic arthritis
- CRP/ESR - Inflammatory disease
What imaging would you undertake and why?
USS/MRI - In early disease. Can see synovitis better.
X-Ray - Changes more apparent in established disease
What would an X-Ray show if a patient had RA?
- Loss of joint space
- Periarticular osteopenia
- Juxta-articular bony erosions
- Subluxation and gross deformity
- Soft tissue swelling
What is the DAS28?
28-joint disease activity score
What is the treatment for RA?
- Initially DMARD monotherapy (usually methotrexate)
- If this doesnt work, add another DMARD (sulfalazine, hydroxychloroquine, leflunomide)
- Corticosteroids acutely for flares (PO/IM)
- NSAID’s with PPI cover to control symptoms if no contraindications
- If DMARD’s dont work, use biologicals (anti-TNF’s)
What does treat to target mean?
Defines a treatment target (low disease activity, low pain) and applies tight control (monthly check ups and treatment adjustment) to reach this target.
