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Y4: Rheumatology > Rheumatoid Arthritis COPY > Flashcards

Rheumatoid Arthritis COPY Flashcards

1
Q

Describe Rheumatoid arthritis?

A
  • Autoimmune
  • More common in women
  • Symmetrical, small-joint polyarthritis
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2
Q

Describe the pathophysiology of RA?

A
  • Autoimmunity triggered by environmental precipitant (eg infection)
  • Inflammatory infiltration into synovial membrane
    • Interaction between CD4 T lymphocytes and B cells
  • Smoking is an important risk factor
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3
Q

What are the joint problems caused by rheumatoid arthritis in the hands?

A
  • Commonly affects MCP and PIP joints of hands
    • Z-thumb
    • Ulnar deviation
    • Muscle wasting
    • Swan-neck deformity at the DIP
    • Boutonniere deformity at the PIP
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4
Q

What effects does RA have on synovium?

A
  • Causes inflammation of the synovium
    • Boggy
    • Rubery
    • Swelling
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5
Q

What are the extra-articular manifestations of rheumaoid arthritis?

A
  • Osteoporosis
  • Felty’s syndrome
    • Triad: RA, neutropenia, splenomegaly
  • Pulmonary fibrosis
  • Peripheral neuropathy
  • Rheumatoid nodules
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6
Q

Name some other differentials for the symptoms of rheumatoid arthritis?

A
  • SLE
  • Gout
  • Osteoarthritis
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7
Q

Who tends to be affected by rheumatoid arthritis?

A
  • 2/3 are women
  • 60-70 year olds
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8
Q

What genetic factor is involved with the development of rheumatoid arthritis?

A
  • HLA-DR4
  • HLA-DRβ1
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9
Q

Name some investigations that can be performed to diagnose rheumatoid arthritis?

A
  • Clinical criteria
  • ESR, CRP
  • Rheumatoid factor, anti-CCP antibodies
  • US or MRI (if still unsure)
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10
Q

Describe the use of blood tests in rheumatoid arthritis?

A
  • ESR
  • CRP
  • Anti-CCP antibodies (ACPA)
  • Rheumatoid Factor (RF)
    • IgM which is positive in 70% RA patients
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11
Q

What signs on x-ray suggest rheumatoid arthritis?

A
  • Osteopaenia
  • Joint erosions
  • Soft-tissue swelling
  • Reduced joint space
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12
Q

Describe how Rheumatoid Arthritis is diagnosed?

A
  • Multi-joint involvement
  • Symptoms >6 weeks
  • Serum postive for RF or ACPA
  • Elevated CRP or ESR
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13
Q

Describe the treatment of RA?

A
  • Analgesia
  • Corticosteroids
  • DMARDs
  • Biologics
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14
Q

Describe analgesia in the treatment of RA?

A

NSAIDs

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15
Q

Describe corticosteroids in the treatment of RA?

A

Bridging therapy for several months until DMARDs become effective

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16
Q

Describe DMARDs in the treatment of RA?

A
  • Methotrexate
  • Second line:
    • Sulfasalazine
    • Hydroxychloroquine
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17
Q

Name some side effects of Methotrexate?

A
  • Rash
  • GI upset
  • Pneumonitis
  • LFT abnormalities
18
Q

Describe a scoring system for RA?

A
  • DAS28 score
    • ESR
    • Patient’s assessment
    • Number of swollen, tender joints
  • Monitors disease acitivty, treatment response and need for biologic therapy
19
Q

What does a patient receviing methotrexate also require?

A
  • Folate supplementation
  • Flu and pneumococcal vaccines
20
Q

Describe biologics in the treatment of RA?

A
  • Anti-TNF alpha
    • Infliximab
  • Anti-CD20
    • Rituximab
21
Q

Describe Psoriatic Arthritis?

A
  • 30% of people with arthritis
  • Distal phalanges
    • Dactylitis
    • “Pencil in cup” deformity
22
Q

What is pictured here?

A

Pencil in cup deformity

23
Q

What is the hallmark of rheumatoid arthritis?

24
Q

What environmental factors can increase the risk of developing RA?

A
  • Smoking
  • Infection
  • Hormonal
    • Pregancy
    • Female prepond
25
Q

When is Methotrexate contraindicated?

26
Q

What are some common side effects of Sulfasalazine ?

A
  • GI upset
  • Rashes
27
Q

What are the risks with Anti-TNFs?

A
  • TB
  • Infection risk
28
Q

What are the risks with Anti-CD20s?

A
  • Infection
  • Hypogammaglobulinaemia
29
Q

Name some non-pharmacological treatments of RA?

A
  • Occupational therapy
  • Phyiostherapy
  • Foot clinics
  • Foot wear adjustments
  • Walking aids
30
Q
A

Boutonniere deformity

31
Q
A

Swan neck deformity

32
Q
33
Q
A
  • Ulnar deviation of digits
  • Radial deviation of wrists
34
Q

If a patient is taking methotrexate for their RA, what other medication should be avoided?

A
  • Trimethoprim
    • Increased risk of haematological toxicity
35
Q

Describe the use of the drug Hydroxychloroquine?

A
  • Used in Mx of SLE and RA
  • May be used if needed in pregnant women
  • SEs:
    • Bull’s eye retinopathy - severe and permanent vision loss
36
Q

Treatment goals in RA?

A
  • Suppress inflammation
  • Control symptoms
  • Prevent joint damage
37
Q

Read these case histories for RA

38
Q

What DMARDs are SAFE to use in pregnancy?

A
  • Sulfasalazine
  • Hydroxychloroquine
  • Azathioprine
39
Q

What DMARDs are UNSAFE to use in pregnancy?

A
  • Methotrexate
  • Cyclophosphamide
  • Mycophenolate

Unsafe in breast feeding too

40
Q

BNF best practice treatment pathways .

41
Q

Interpretation of the DAS28 score

Y4: Rheumatology (19 decks)

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