Rheumatoid Arthritis Clinical

Question 1

Definition of RA

Answer 1

Chronic autoimmune systemic illness characterised by a symmetrical peripheral arthritis and other systemic features.

Question 2

Criteria for the Diagnosis of RA

Answer 2

A. Joint Involvement, 1 large joint (0), 2-10 large joints (1), 1-3 small joints (2), 4-10 small joints (3), >10 joints (at least one of which is a small joint) (5).

B. Serology. Negative RF and negative ACPA (0), Low +RF or low + ACPA (2), high +RF or high +ACPA (3)

C. Acute-Phase Reactants. Normal CRP and Normal ESR (0), Abnormal CRP or abnormal ESR (1)

D. Duration of symptoms
<6 weeks (0)
>6 weeks (1)

A SCORE OF MORE THAN 6/10 INDICATES DEFINITE RA

Question 3

Prevalence of RA

Answer 3

1% of population

Question 4

Female to Male Ratio of RA

Answer 4

3:1

Question 5

Age of onset of RA

Answer 5

40/50 years.

Question 6

Aetiology of RA

Answer 6

HLA-DRB1
Cigarette smoking
Peridontal Disease

Question 7

Pathology of RA

Answer 7

Inflamed synovial membrane due to T lymphocytes and macrophages. Major cell type within the synovial fluid is neutrophils.

Question 8

Immunological Investigation of RA

Answer 8

Presence of RF, antiCCP and ACPA.

Question 9

Radiological investigation of RA

Answer 9

Loss of cartilage, erosions, mechanical problems of subluxation.

US will show inflammation within the joint.

Question 10

Symptoms of RA

Answer 10

Pain (joint pain in various joints)
Stiffness
Immobility 
Poor function 
Systemic Symptoms - nonspecific or specific (eyes, lungs, nerves, skin, kidneys)

Question 11

Clinical Signs of RA

Answer 11

Swelling
Joint tenderness
Limitation of movement
Redness and heat around the joint 
Subluxation of the joints

Question 12

Assessment of RA

Answer 12

Disease Activity Score (DAS28).
A DAS<2.4 represents clinical remission.
DAS>5.1 represents eligibility for biological therapy.