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Medicine: Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

Chronic autoimmune condition involving inflammation of the synovial lining of the joints, tendon sheaths, and bursa.

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2
Q

Is rheumatoid arthritis symmetrical or asymmetrical?

A

Symmetrical usually

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3
Q

What is this a presentation of?

Middle aged woman with symmetrical distal joint pain, swelling, and stiffness, some systemic symptoms.

A

Rheumatoid arthritis

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4
Q

Which genes are associated with rheumatoid arthritis?

A
  1. HLA DR4 - often present in RF +ve patients

2. HLA DR1 - occasionally present in RF +ve patients

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5
Q

Which antibodies are present in rheumatoid arthritis?

A
  1. Rheumatoid factor (70%) - targets Fc portion of Ig

2. Cyclic citrullinated peptide antibodies (anti-CCP) - more sensitive and specific

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6
Q

What is palindromic rheumatism and what condition is it associated with?

A
  1. Self-limiting episodes of inflammatory arthritis, last 1-2 days, +ve RF/anti-CCP may indicate it will progress.
  2. Rheumatoid arthritis
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7
Q

Which joints are commonly affected in rheumatoid arthritis?

A
  1. PIP, MCP
  2. Wrist and ankle
  3. MTP
  4. Cervical spine
  5. Knees, hips, shoulders
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8
Q

What is atlanto-axial subluxation, what causes it, what are the complications, and how is it identified?

A
  1. C2 and odontoid peg shift within C1.
  2. Local synovitis and damage to structures around peg.
  3. Spinal cord compression (emergency)
  4. MRI visualises changes
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9
Q

What does z-shaped deformity of the thumb indicate?

A

Rheumatoid arthritis

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10
Q

What is swan neck deformity and what does it indicate?

A
  1. Hyperextended PIP with flexed DIP

2. Rheumatoid arthritis

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11
Q

What is Boutonnière deformity and what does it indicate?

A
  1. Hyperextended DIP with flexed PIP

2. Rheumatoid arthritis (uncommon finding)

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12
Q

Which joint is affected in ulnar deviation of the fingers at the knuckle and what does it indicate?

A
  1. MCP

2. Rheumatoid arthritis

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13
Q

Is a boggy feeling in the joints more typically OA or RA?

A

Rheumatoid arthritis

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14
Q

What are the lung manifestations of rheumatoid arthritis?

A
  1. Pulmonary fibrosis with pulmonary nodes (Caplan’s syndrome)
  2. Bronchiolitis obliterans (inflammation causing small airway destruction)
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15
Q

What are the haematological manifestations of rheumatoid arthritis?

A
  1. Felty’s syndrome (RA, neutropenia, splenomegaly)

2. Anaemia of chronic disease

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16
Q

What is the exocrine manifestation of rheumatoid arthritis?

A

Secondary Sjogren’s syndrome (sicca syndrome)

17
Q

What are the ophthalmological manifestations of rheumatoid arthritis?

A

Scleritis and episcleritis

18
Q

Which investigations are required alongside a clinical presentation to diagnose rheumatoid arthritis?

A
  1. Rheumatoid factor, if negative check anti-CCP
  2. Inflammatory markers - CRP and ESR
  3. X-ray of hands and feet
  4. USS to confirm synovitis (when clinical examination findings are unclear)
19
Q

What are the x-ray changes in rheumatoid arthritis?

A
  1. Joint destruction and deformity
  2. Soft tissue swelling
  3. Periarticular osteopenia
  4. Bony erosions
20
Q

When should rheumatoid arthritis be referred to rheumatology?

A
  1. Persistent synovitis (even if Abs -ve)

2. Involving small joints/multiple joints/symptoms present over 3 months - URGENT referral

21
Q

What is the basis for scoring a patient suspected of having rheumatoid arthritis?

A
  1. Joints involved - more points for small joints
  2. Serology - RF/anti-CCP
  3. Inflammatory markers - CRP/ESR
  4. Duration of symptoms - more or less than 1 week
    Greater than or equal to 6 = rheumatoid arthritis
22
Q

What is the DAS28?

A

Disease activity score, based on assessment for 28 joints, rheumatoid arthritis.

23
Q

Which factors indicate a worse prognosis in rheumatoid arthritis?

A

Younger, male, more joints and organs involved, presence of RF and anti-CCP, erosions on x-ray.

24
Q

What is the pharmaceutical management of rheumatoid arthritis?

A
  1. Short course of steroids/NSAIDs/COX-2 inhibitors
  2. DMARDs - methotrexate/leflunomide/sulfasalazine
  3. Try combining, then try with biological therapy
  4. Hydroxychloroquine for mild cases
25
Q

How does methotrexate work and what needs to be taken alongside it?

A
  1. Interferes with folate metabolism to suppress components of immune system.
  2. Folic acid taken on different day
26
Q

What is the major notable side effect of methotrexate?

A

Pulmonary fibrosis

27
Q

How does leflunomide work and what are the two notable side effects?

A
  1. Immunosuppression, interferes with pyrimidine production.

2. Hypertension and peripheral neuropathy

28
Q

What is sulfasalazine for and what is it’s notable side effect?

A
  1. Immunosuppression and anti-inflammatory

2. Temporary male infertility (low sperm count)

29
Q

What are the major notable side effects of hydroxychloroquine?

A

Nightmares and reduced visual acuity (macular toxicity)

30
Q

What are the major notable side effects of anti-TNF medications?

A

Reactivation of TB and hepatitis B

31
Q

What are the major notable side effects of rituximab?

A

Night sweats and thrombocytopenia

Medicine: Rheumatology (19 decks)

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