Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Rheumatoid arthritis (MSK) > Flashcards

Rheumatoid arthritis (MSK) Flashcards

1
Q

What is rheumatoid arthritis?

A

Chronic, erosive, inflammatory autoimmune disorder that primarily affects the joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is rheumatoid arthritis associated with?

A

Other autoimmune diseases e.g. Sjogren’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who does rheumatoid arthritis usually affect?

A
  • F > M
  • 40-60 year olds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What assessments are used routinely to provide optimum care for rheumatoid arthritis patients? (4)

A
  • disease activity scores (DAS28)
  • clinical disease activity index (CDAI)
  • simplified disease activity index (SDAI)
  • routine assessment patient index data (RAPID3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What factors seem to be most abundant in the joint in rheumatoid arthritis? (3)

A
  • TNF
  • IL-1
  • IL-6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the aetiology of rheumatoid arthritis. (Low yield)

A
  • IgM anti-IgG antibody
  • increased angiogenesis, cellular hyperplasia, influx of inflammatory cells, change in expression of cell surface adhesion molecules and cytokines
  • infiltration of T cells, B cells, macrophages and plasma cells
  • TNF, IL-1, IL-6 most abundant in joint
  • high levels of metalloproteinase activity thought to contribute to joint destruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the pattern of joint involvement in rheumatoid arthritis?

A
  • symmetrical polyarthritis affecting small joints of hands and feet
  • MCP, PIP, MTP
  • DIP spared
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the clinical features of rheumatoid arthritis?

A
  • typical picture: symmetrical, swollen, painful, stiff small joints of hands and feet, morning stiffness >30min that improves with activity
  • gradual onset
  • polyarthritis
  • systemic symptoms: fever, fatigue, weight loss, pericarditis, pleurisy
  • rheumatoid nodules (non-tender, firm, subcutaneous nodules)
  • uveitis/scleritis/episcleritis
  • hand deformities (ulnar deviation, swan neck deformity, Boutonniere finger deformity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What systemic symptoms can be seen in rheumatoid arthritis? (5)

A
  • fever
  • fatigue
  • weight loss
  • pericarditis
  • pleurisy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some extra-articular features of rheumatoid arthritis? (2 + 1)

A
  • rheumatoid nodules: non-tender, firm, subcutaneous nodules
  • uveitis and/or scleritis (erythema and pain) /episcleritis (erythema only)
  • can also lead to lymphadenopathy, vasculitis, fibrosing alveolitis, obliterative bronchiolitis, pleural and pericardial effusion, Raynaud’s, carpal tunnel syndrome, peripheral neuropathy, splenomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What hand deformities can be seen in late stage rheumatoid arthritis? (3)

A
  • ulnar deviation
  • swan neck deformity (MCP flexion, PIP extension, DIP flexion)
  • Boutonniere finger deformity (PIP flexion, DIP hyperextension - like pushing a button)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some risk factors for rheumatoid arthritis? (4)

A
  • genetic predisposition: HLA-DR1, HLA-DR4
  • smoking
  • overweight/obesity
  • infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Felty’s syndrome? (3)

A

Rheumatoid arthritis + splenomegaly + low WCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 1st line investigations for rheumatoid arthritis? (4)

A
  • rheumatoid factor (RF)
  • anti-cyclic citrullinated peptide antibody (anti-CCP)
  • radiographs
  • ultrasonography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What might bloods show in rheumatoid arthritis?

A
  • FBC - low Hb (anaemia of chronic disease), high platelets (inflammation)
  • high CRP&ESR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do antibody tests show in rheumatoid arthritis?

A
  • rheumatoid factor: +ve in 70% of RA patients, more sensitive
    • associated with rheumatoid nodules and extra-articular manifestations
  • anti-CCP: (30% patients) highly specific test, +ve in 40% of patients who test negative for RA
17
Q

What scan do we do in all patients with suspected rheumatoid arthritis?

A

NICE recommends performing x-rays of hands and feet

18
Q

What would a joint x-ray show in rheumatoid arthritis?

A

BONDS

  • Bone erosions
  • Osteopenia/osteoporosis (juxta-articular)
  • Narrowing of joint space
  • Deformity
  • Soft tissue swelling
19
Q

What would ultrasound of joints in rheumatoid arthritis show?

A

Synovitis of wrist and fingers, have more sensitivity in detecting bone erosions

20
Q

What would joint aspiration show in rheumatoid arthritis?

A
  • high WCC - polymorphonuclear neutrophils
  • turbid, yellow
  • absence of crystals
21
Q

What scoring system is used to follow disease activity in rheumatoid arthritis?

A

DAS28 (and CRP)

22
Q

What are some differential diagnoses for rheumatoid arthritis? (5)

A
  • psoriatic arthritis - asymmetrical small joints, DIP, psoriasis
  • infectious arthritis
  • gout - high levels uric acid, larger erosions, urate crustals
  • SLE - high ANA and ENA autoantibodies, no erosions
  • osteoarthritis - old age, large joints, pain worse with activity, LOSS on XR, morning stiffness only few minutes
23
Q

How is rheumatoid arthritis GENERALLY managed? (2)

A
  • DMARDs to slow disease progression
    • initial: DMARD monotherapy +/- short course of bridging prednisolone
  • NSAIDs
24
Q

How do we manage acute mild rheumatoid arthritis at initial presentation?

A
  • DMARDs (hydroxychloroquine, sulfasalazine, methotrexate)
  • PLUS corticosteroid (prednisolone with calcium and vitamin D)
  • PLUS NSAIDs (ibuprofen, naproxen, diclofenac - CI in any form of CVD)
25
Q

How do we manage acute moderate-severe rheumatoid arthritis at initial presentation?

A
  • DMARD
  • biological agent e.g. TNF-a inhibitor (etanercept/infliximab/adalimumab)
  • PLUS oral Janus kinase (JAK) inhibitor (e.g. tofacitinib, baricitinib, upadacitinib)
26
Q

How do we manage acute rheumatoid arthritis if pregnant?

A

Corticosteroid (prednisolone), sulfasalazine or hydroxychloroquine

(Methotrexate is teratogenic)

27
Q

What needs to be co-prescribed with methotrexate?

A

Folate to reduce risk of myelosuppression, as methotrexate is an anti-folate

28
Q

What are some side effects of methotrexate? (4)

A
  • pneumonitis (cough, SOB, fever)
  • mucositis
  • pulmonary fibrosis
  • liver fibrosis
  • (immunosuppression if folate not co-prescribed)
29
Q

What can be prescribed if there is an inadequate response to at least 2 DMARDs in rheumatoid arthritis?

A

Infliximab (TNF-a inhibitor) - but may reactivate TB

30
Q

How are acute flares of rheumatoid arthritis managed?

A

Oral or IM steroids e.g. prednisolone/methylprednisolone

31
Q

How is ongoing rheumatoid arthritis managed (failure to reach low disease activity after 3 months of therapy)?

A
  • 1st line: methotrexate + biological agent (infliximab)
  • 2nd line: methotrexate + hydroxychloroquine + sulfasalazine (triple DMARD therapy)
  • consider corticosteroid+NSAID
32
Q

What are rituximab and abatacept for rheumatoid arthritis?

A
  • emerging treatments
  • rituximab: anti-CD20 monoclonal antibody –> B-cell depletion, infusion reactions common
  • abatacept: fusion protein that modulates key signal required for T cell activation –> decreased T-cell proliferation and cytokine production
33
Q

What are some complications of rheumatoid arthritis?

A
  • work disability
  • increased joint replacement surgery
  • increased coronary artery disease
  • increased mortality
  • ILD
  • Felty syndrome (RA+splenomegaly+low WCC)
  • carpal tunnel syndrome
  • methotrexate-induced liver toxicity and lung involvement
  • TNF-a inhibitor-related infections
  • TNF-a inhibitor-related malignancy
34
Q

Describe the prognosis of rheumatoid arthritis.

A

Patients treated aggressively and early have a good prognosis with most patients achieving good disease control

Year 3 (148 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions