Rheumatoid Arthritis - Clinical Flashcards
Symptoms of Rheumatoid Arthritis
Hand joint pain Morning joint stiffness for more than 30 minutes Symptoms improve throughout the day Joint swelling Knee effusions Bilateral swollen ankle Raised ESR, CRP
Investigation/Review for RA Patient
Confirm widespread synovitis
Positive RF
Positive anti CCP antibody
Baseline hand and foot x ray
Treatment for RA
Glucocorticoids
Initiation of DMARD therapy
Patient information
Example of DMARD therapy
Sulfasalazine
Describe what is involved in an RA follow-up
Monthly appointments in Early Arthritis Clinic (nurse-led)
- Monitor disease activity DAS28
- Monitor blood test
- Patient education
- Multidisciplinary assessment
What HCPs are involved in an RA MDT?
Specialist nurse OT Physio Pharmacist Clinical Psychologist Podiatrist Orthotics
What treatment can be given if patient experiences flare ups after initial DMARD therapy?
IM Steroid
Methotrexate
Biologics
What is assessed prior to initiating biologic treatment?
TB Vaccination scar
Chest x-ray
Chronic blood-borne viral screening
VZV Serology
Example of biologic used to treat RA
Anti-TNF alpha
What are the complications of RA?
Orthopaedic complications
Extra-articular involvement
Cardiovascular risk
Socioeconomic implications
What orthopaedic complications can occur due to RA?
Chronic synovitis Pain Deformities Poor function Secondary osteoarthritis
Three examples of extra-articular involvement due to RA
Rheumatoid nodules
Interstitial lung disease
Vasculitis
Management of Functional Impairment associated with RA
Vertebral fractures (can occur with OA) Special adaptive cutlery Adaptive footwear Walking aids Wheelchair Family support Care package
ARA 1987 Criteria for diagnoses of RA (7 points)
Morning stiffness Arthritis of 3 or more joint areas Arthritis of hand Symmetric arthritis Rheumatoid nodules Serum Rheumatoid Factors Radiographic change
EULAR/ACR 2010 Criteria for RA diagnosis
6 or more of Joint involvement - one large joint/2-10 small joints/ 1-3 small/4-10 small/greater than 10 Serology Acute Phase Reactants Duration of Symptoms
2 factors to be eligible for investigation of RA under EULAR/ACR criteria
Definite clincal synovitis
Swelling cannot be explained by another illness
Ratio of RA Male to Female
1 to 3
Average age to be diagnosed with RA
Presents 4th/5th decade
Genetic and environmental factors contributing to RA
Smoking
Chronic infection
HLA DRB 1
Investigations for RA
Rheumatoid Factor - IgG, IgM
Anti CCP antibodies , ACPA
Symptoms of RA
Pain Stiffness Immobility Function Systemic symptoms
Signs of RA
Swelling Tenderness Limitation of movement Redness Heat
Non-specfic systemic features of RA
Weight loss
Fatigue
Anaemia
Specific systemic symptoms of RA
Eyes Lungs Nerves Skin - nodules Kidneys
Long-term associations and risks of RA
Cardiovascular
Malignancy
Assessment of RA - Disease Activity Score (DAS)
<2.4 Clinical remission
>5.1 eligible for biologic therapy
4 Treatment approaches of inflammatory Arthritis
Medicines
Injections
Therapies
Surgeries
Therapeutic categories for RA treatment
NSAIDs
DMARDs
Biologics
Corticosteroids
4 examples of DMARDs
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Treatment strategies for early aggressive intervention
Sequential Monotherapy
Combination
Targeted Therapy
Mechanism of Biologics
Target aspects of inflammatory cascade
Examples of Biologics
Anti TNF alpha IL-1 inhibitors Anti B cell therapies - Rituximab Anti T cell therapy - Abatacept IL-6 inhibitors - Tocilizumab
Biologic therapy will have an enhanced effect in RA in conjunction with which other medication?
Methotrexate -DMARD
Methods of Corticosteroid administration
Oral, IV, IM
What factors need considered when prescribing corticosteroids?
Short term benefit versus long term toxicity
Inappropriate as single drug therapy in most cases
