Rheumatoid Arthritis (RA)

Question 1

What type of arthritis is rheumatoid arthritis

Answer 1

Poly arthritis

Question 2

What are features of RA

Answer 2

Symmetrical
Destructive

Question 3

What are commonly affected areas in RA

Answer 3

Hands (MCPs and PIPs)
Wrists
Feet (MTPs PIPs)
Knees
Shoulders
Elbows
C1-C2 (atlantoaxial)

Question 4

What area is most commonly affected

Answer 4

Hands (90% of cases)

Question 5

How are the hands affected in RA

Answer 5

Primarily affects the synovium
MCP and PIP
Wrist joint

Question 6

What are possible deformities created in hand RA

Answer 6

Ulnar drift
Swan neck deformity ( DIP flexion with PIP hyperextension)

Question 7

what is the approx. cases for feet RA

Answer 7

60%

Question 8

How are the feet affected in RA

Answer 8

MTPs and PIPs
Joint deformities including bunions and hammertoes

Question 9

What non joint effects does RA cause?

Answer 9

Bone erosion
Rheumatoid ‘nodules’
Sjogrens syndrome
Various comorbidities

Question 10

What does RA bone erosion involve

Answer 10

Focal bone loss to subchondral and joint margins
local osteopenia
Generalised osteoporosis

Question 11

What is osteopenia

Answer 11

When an area has low bone density or mass caused by reduced minerals in that area

Question 12

What is Sjogrens syndrome

Answer 12

30% of people with RA develop Sjogren’s Syndrome
affects exocrine glands, particularly the salivary and lacrimal glands
leads to dry eyes and dry mouth

Question 13

What are common comorbidities in RA

Answer 13

Stroke
Sleep issues
Depression and anxiety
Eye problems
Heart disease
Lung problems
Vasculitis
Blood disease
Diabetes
Osteoporosis

Question 14

What is the epidemiology of RA

Answer 14

Female:male 3:1 ratio
Onset any age (peak 30-50 yrs)
1% of the UK population
~1/3 stop work within 2 yrs of onset (increased rate post 2 yrs)
~18 million ppl worldwide living with RA
Smoking significant risk factor with RA

Question 15

What are risk factors for / in RA

Answer 15

Oral health:
Chronic periodontitis, tooth loss

Sex-specific factors:
Post menopause
Anit-oestrogen treatment
Oral contraceptives/HRT
Parity
Breastfeeding

Lifestyle and habits:
Obesity
Stress
Exercise

Respiratory exposure:
Inhaled pollution
Smoking
Silica Dust
COPD
Asthma

Genetics:
HLA shared epitope alleles
Family history
Ethnicity
Epigenetics

Intestinal Health
Chronic Diarrhoea
Inflammatory/western diet (?)
Sugar-sweetened beverages
Microbiota
Coffee
Mediterranean diet(?)
Tea(?)
Alchohol

Question 16

How is it diagnosed

Answer 16

Clinical history
Blood tests:
Increased ESR (coagulation of blood cells)
Increased CRP
Rheumatoid factor = ‘seropositive’ (60-80% specificity)
Anti-cycle citrullinated peptide (Anti-CCP) antibodies (95-98% specificity)