Rheumatoid Arthritis/RA (2) Flashcards
What is it
What are its risk factors?
➊ Autoimmune, symmetrical polyarthritis condition of chronic inflammation of synovial lining in joints, tendon sheaths and bursa
➋ • Female - 3x more common than men
• Family hx
• Smoking
• Genetic associations - HLA DR4/DR1
How does it present?
How can it be differentiated from OA?
What may be found O/E?
What is Palindromic Rheumatism ?
Which deformities may be seen in the hand?
What are its associated extra-articular manifestations?
➊ • Symmetrical, poly-articular pain and stiffness of joints of the hand, wrists and feet
• Prolonged morning stiffness (> 30 mins)
➋ • Improves with movement, worse with rest
• DIP is usually spared in RA, so if affected, it’s most likely OA (Heberden’s)
➌ Swollen, red, warm, and tender joints
➍ Recurrent, short lived (hrs to days) episodes of arthritis in different joints before settling into a more permanent form
➎ • Swan-neck deformity
• Boutonniere’s deformity
• Ulnar deviation at knuckles
• Z shaped deformity of thumb
➏ • Carpal tunnel syndrome
• Pulmonary Fibrosis
• Raynauds
• Pleural Effusion
• Bronchiolitis Obliterans (inflammation causing bronchiole destruction)
Investigations:
How is it diagnosed?
Which bloods are needed to confirm the diagnosis?
What other bloods may be done?
What will be seen on XR?
➊ Clinically
➋ • RF - +ve in ~70%
‣ If -ve, check anti-CCP - very specific for RA (if -ve, you can rule it out)
➌ • FBC - common for these pts to have anaemia of chronic disease
• CRP and ESR
➍ Joint destruction and deformity, soft-tissue swelling, periarticular osteopenia, and bony erosions
Management:
What is given for symptomatic relief?
What score is used to monitor disease activity?
What can be given to slow disease progression?
→ What are the 1st line options of these?
→ When are these indicated?
→ If on these, what should they be given? Why?
When does methotrexate have to be used with caution?
→ How are these cases managed?
➊ • Paracetamol and NSAIDs for pain, swelling and stiffness
• Intra-articular/oral Steroids during flare-ups
• Physiotherapy
➋ DAS28 - Disease Activity Score, and is out of 28 - Includes:
• Swollen joints
• Tender joints
• CRP/ESR levels
➌ DMARDs and Biologics - Early use of these improves long-term outcome
→ Methotrexate (D), Sulfasalazine (D), Hydroxychloromide (D), Infliximab (B)
→ DAS28 > 5.1
→ Annual Influenza vaccine and the Pneumococcal vaccine every 5 years
➍ Pregnancy as it’s teratogenic
→ Avoid methotrexate around conception
