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0-Finals Rheumatology > Rheumatoid arthritis (O) > Flashcards

Rheumatoid arthritis (O) Flashcards

1
Q

What is RA?

A

AI condition causing chronic inflammation on synovial lining on joints, tendon sheaths and bursa

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2
Q

What type of arthritis is RA?

A

Inflammatory

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3
Q

What is synovitis?

A

Inflammation of synovial linings

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4
Q

What is usual distribution of RA?

A

Symmetrical

Affects multiple joints

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5
Q

Who is likely to get RA?

A
  • Women
  • Middle age
  • Fam Hx

Genetic associations:

  • HLA DR4
  • HLA- DR1
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6
Q

Presentation of RA?

A 
Symmetrical Distal polyarthropathy 
Key symptoms: 
- Pain 
-Swelling 
-Stiffness

Assoc symptoms:

  • Fatigue
  • Wt loss
  • Muscle aches/weakness
  • Flu-like
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7
Q

Pain from OA different to pain from RA how?

A

Pain from OA: Better after rest, worse after activity

Pain from RA: Better after activity, worse after rest

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8
Q

What is palindromic arthritis?

A

Short episodes of 1-2 days

Self-limiting inflammatory arthritis

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9
Q

Atlanto-axial subluxation?

A

Caused by local synovitis and ligament/bursa damage
-In the cervical spine, Axis (C2) and odontoid peg, shift within atlas (C1)
Can cause spinal cord compression= emergency

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10
Q

Signs on hands of RA?

A

On synovium palpation it feels boggy around joints

  • Z-shaped thumb deformity
  • Swan-neck deformity
  • Boutonnieres deformity
  • Ulnar deviation of fingers at MCP joints
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11
Q

What is swan neck deformity?

A

Hyperextended PIP + flexed DIP

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12
Q

What is Boutonnieres deformity?

A

Hyperextended DIP + Flexed PIP

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13
Q

Extra-articular manifestations of RA?

A
  • Pulmonary fibrosis + pulmonary nodules = Caplan’s
  • Bronchiolitis Obliterans (Inflammation = Small airway destruction)
  • Felty’s syndrome (RA, neutropenia and splenomegaly)
  • Secondary Sjogren’s syndrome
  • Anaemia
  • CVD
  • Rheumatoid nodules
  • Lymphadenopathy
  • Carpal tunnel syndrome
  • Amyloidosis
  • Eye manifestations
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14
Q

Eye manifestations of RA?

A
  • Scleritis
  • Episcleritis
  • Keratitis
  • Keratoconjunctivitis sicca
  • Cataracts (steroid caused)
  • Retinopathy (secondary to chloroquine)
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15
Q

Investigation for RA?

A

Clinical Diagnosis +

  • Check RF
  • If RF -ve, check anti-CCP antibodies
  • Inflammatory markers (CRP & ESR)
  • X-ray of hands & feet

US scan of joints confirms synovitis

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16
Q

X-ray changes seen in RA?

A
  • Joint destruction/deformity
  • Soft tissue swelling
  • Periarticular osteopenia
  • Boney errosions
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17
Q

Diagnosis of RA is based on?

A
  • Joints involved (more and smaller score higher)
  • Serology (RF and anti-CCP)
  • Inflammatory markers (ESR & CRP)
  • Duration of symptoms (6 weeks?)
18
Q

What does DAS Score monitor?

A

Disease activity:

Assessment for 28 joints and points for swelling, tenderness and ESR/CRP result

19
Q

Prognosis of RA is worse if?

A

You are:

  • Male
  • Young onset
  • More affected joints
  • Erosions on x-ray
  • RF & anti-CCP antibodies
20
Q

Management of first presentation?

A

Short course of steroids (NSAIDs can be used but bleeding risk therefore + PPI)

21
Q

NICE guidelines for DMARDs?

A

1st line: Monotherapy with methotrexate, leflunomide or sulfasalazine

Hydroxychloroquine can be considered in mild disease

2nd line: 2 of these used in combo

3rd line: Methotrexate + biological therapy usually TNF inhibitor

4th line: Methotrexate + rituximab

22
Q

Methotrexate indications?

A

Once a week via tablet or injection
Alongside
Folic acid 5mg taken on one weekly on a day methotrexate isn’t taken in a week

23
Q

Side effects of methotrexate?

A
  • Mouth ulcer/mucositis
  • Liver toxicity
  • Pulmonary Fibrosis
  • Teratogenic
  • Bone marrow suppression & leukopenia
24
Q

What is lefluonomide?

A

Immunosuppressant

25
Q

What does leflunomide do?

A

Interferes with pyrimidine production (component of DNA or RNA)

26
Q

Side effects of leflunomide?

A
  • Mouth ulcers/mucositis
  • Increased BP
  • Liver toxicity
  • Peripheral neuropathy
  • Bone marrow suppression
  • Teratogenic
27
Q

What is sulfalsazine?

A

Immunosuppressive & anti-inflammatory

28
Q

Side effects of sulfasalazine?

A
  • Temporary male infertility

- Bone marrow suppression

29
Q

What is hydroxychloroquine traditionally used as?

A

Antimalarial drug

30
Q

Side effects of hydroxychloroquine?

A
  • Nightmares
  • Reduced visual acuity
  • Skin pigmentation
  • Liver toxicity
31
Q

What do anti-TNF drugs do?

A

Block TNF reduced inflammation

32
Q

Examples of anti-TNF drugs?

A 
Adalimumab 
Golimumab 
Infliximab 
Certolizumab pegol 
-Etanercept
33
Q

Side effects of anti-TNF drugs?

A
  • Vulnerability to sepsis and infections

- Reactivation of Hep B/TB

34
Q

What is ritixumab?

A

Monoclonal AB targetting CD20 protein on B cells surface

35
Q

Side effects of rituximab?

A
  • Vulnerability to severe infections/sepsis
  • Night sweats
  • Thrombocytopenia
  • peripheral neuropathy
  • Liver and lung toxicity
36
Q

Unique side effect of methotrexate?

A

Pulmonary fibrosis

37
Q

Unique side effect of leflunomide?

A

HT

Peripheral neuropathy

38
Q

Unique side effect of Sulfasalazine?

A

Male infertility

39
Q

Unique side effect of hydroxychloroquine?

A

Nightmares

Reduced visual acuity

40
Q

Unique side effects of Anti-TNF meds?

A

Reactivation of Hep B/TB

41
Q

Unique side effects of rituximab?

A

Night sweats

Thrombocytopenia

0-Finals Rheumatology (20 decks)

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