Rheumatoid Arthritis Treatment 2 Flashcards
What are the clinical features of RA
- inflammatory polyarthritis is central
- particularly small joints of hands and feet
- 80% of RA patients have RF and anti CCP antibodies
- inflammatory markers are raised
- joint erosion and destruction can occur
- joints become swollen and tender (synovitis)
explain how joint changes occur in RA
- synovial cells within joint are attacked and replaced with scar tissue
- due to the inflammation, you get local immune cells in that area, leading to vasodilation
- ultimately leads to bone erosion
what is the metacarpophalangeal joint
knuckle joint
what is the proximal interphalangeal joint
next knuckle joint
what is the distal interphalangeal joint
last knuckle joint
what features can be seen in the joints of RA patients
- swan neck deformities
- boutonniere
- ulnar drift
describe the patterns of onset of RA
- gradual- most common, small joints, EMS prominent and symmetrical
- slow monoarticular- less common, larger joints spreading to smaller joints over weeks
- abrupt, acute polyarthritis- widespread affecting small and large joints leading to incapacity
what are the patterns of progression of RA
- lots of inter patient variability
- brief/self limited
- palindronic
- prolonged and progressive
- all of the above can range from mild to severe
how can disease activity be assessed
DAS classification
- difference between 2 scores
- eg. a year apart can show progression
what is the HAQ-DI score
a health assessment questionnaire disability index
describe the prognosis of RA
- HAQ score at baseline is predictor of outcome
- radiographic changes at baseline are a poor indicator
- acute phase reactants predict damage
- in early treatment, tight control is key
give examples of early articular features of RA
pericarditis, pulmonary fibrosis, sc rheumatoid nodules
what are nodules
fibrous growth caused by pooling of rheumatoid factor immune complexes
describe the pulmonary involvement in RA
- occurs frequently
- pulmonary nodules
- interstitial lung disease happens in 7% of RA patients but they have a 3 fold increase in risk of death
Describe how RA is linked to cardiac disease
- RA may lead to generalised vascular disease or pericarditis
- CVD is common and risk of cardiac death is high
- important to treat risk- antiplatelets, statins, antihypertensives
- DMARD therapy significantly lowers risk
what is episcleritis
sudden onset of redness and pain
describe the ocular involvement in RA
- episcleritis and sicca syndrome is also common
what is sicca syndrome
dry eyes due to inflamed tear ducts
what are the genetic links in RA
many chronic inflammatory diseases have been shown to occur preferentially in individuals carrying certain variants of genes in the MHC
describe the contribution of genetic factors to RA
- twin and family studies show contribution of genetic factors to RA
- HLA-DRB1 is the most likely genetic link
- modified by smoking and other environmental factors
how is rheumatoid factor linked to RA
- detected in 50-80% of RA patients depending on stage of disease
- predicts disease
- high titre means more severe RA, rapid progression and worse outcome - autoantibodies recognise antigens on IgG
- leads to complement fixation
what does ACPA stand for
anti citrullinated peptide antibodies
describe the role of ACPAs in RA
- RA patients have epitopes that come from citrulline, recognised by autoantibodies
- ACPA test is the way we check for these antibodies
- highly specific
what are the 2 most common PIP/DIP deformities seen in RA? why is avoiding these deformities in particular, important in any treatment plan?
- swan neck deformity and boutonniere
- these deformities have a significant impact on a patients daily living and therefore significantly affect quality of life
- we want to try to avoid those at all costs because those are the goals that you want for any successful treatments
