Rheumatoid Arthritis - Investigations and Management

Question 1

How is RA mainly diagnosed?

Answer 1

Clinical symptoms

Question 2

What bloods can be used to confirm?

Answer 2

CRP - Shows inflammation

ESR- shows inflammation but affected by many things

RF - Positive in majoirty but increases with age

Anti ccp - More specific but less sensitve

Question 3

When is a CXR used in RA?

Answer 3

?Rheumatoid nodules

Question 4

How can an US help?

Answer 4

Shows increased blood flow toward joint

Question 5

What are the 4 types of treatment?

Answer 5

1. Analgesia/NSAIDS
2. Steroids
3. DMARDs
4. Biological

Question 6

What are the NSAIDS and how do they work?

What should you be aware of?

Answer 6

Ibruprofen, Naproxen

Reduce inflammation but be awared of IHD and GI symptoms (bleeds and ulcers)

Question 7

How do the steroids work?

Answer 7

Reduce immune response and can be given intra/peri articular

Question 8

How do DMARDS work and whay are they?

Answer 8

Disease Modifying Anti Rheumatic Drugs - They attempt to alter the course of the disease, not just mask symptoms.

Methotrexate - Inhibits T cells

Sulphasolazine - Suppresses TNF1 and Il1

Leflunomide - Inhibits lymphocyte production

Question 9

What are the biological agents?

Answer 9

They also try and alter the course of the disease

infliximab and adalimumab are anti tnf

Etanercept is anti TNF

Risk of causing infection due to immune suppression

Question 10

What are the five radiological signs of RA?

Answer 10

Joint space narrowing

Erosions

Subchondral osteopenia

Joint subluxation

Soft tissue swelling