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PY365 Autoimmune Cluster > Rheumatoid Arthritis Treatment 2 > Flashcards

Rheumatoid Arthritis Treatment 2 Flashcards

1
Q

What are the clinical features of RA

A
  1. inflammatory polyarthritis is central
  2. particularly small joints of hands and feet
  3. 80% of RA patients have RF and anti CCP antibodies
  4. inflammatory markers are raised
  5. joint erosion and destruction can occur
  6. joints become swollen and tender (synovitis)
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2
Q

explain how joint changes occur in RA

A
  1. synovial cells within joint are attacked and replaced with scar tissue
  2. due to the inflammation, you get local immune cells in that area, leading to vasodilation
    - ultimately leads to bone erosion
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3
Q

what is the metacarpophalangeal joint

A

knuckle joint

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4
Q

what is the proximal interphalangeal joint

A

next knuckle joint

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5
Q

what is the distal interphalangeal joint

A

last knuckle joint

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6
Q

what features can be seen in the joints of RA patients

A
  1. swan neck deformities
  2. boutonniere
  3. ulnar drift
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7
Q

describe the patterns of onset of RA

A
  1. gradual- most common, small joints, EMS prominent and symmetrical
  2. slow monoarticular- less common, larger joints spreading to smaller joints over weeks
  3. abrupt, acute polyarthritis- widespread affecting small and large joints leading to incapacity
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8
Q

what are the patterns of progression of RA

A
  1. lots of inter patient variability
  2. brief/self limited
  3. palindronic
  4. prolonged and progressive
    - all of the above can range from mild to severe
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9
Q

how can disease activity be assessed

A

DAS classification
- difference between 2 scores
- eg. a year apart can show progression

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10
Q

what is the HAQ-DI score

A

a health assessment questionnaire disability index

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11
Q

describe the prognosis of RA

A
  1. HAQ score at baseline is predictor of outcome
  2. radiographic changes at baseline are a poor indicator
  3. acute phase reactants predict damage
  4. in early treatment, tight control is key
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12
Q

give examples of early articular features of RA

A

pericarditis, pulmonary fibrosis, sc rheumatoid nodules

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13
Q

what are nodules

A

fibrous growth caused by pooling of rheumatoid factor immune complexes

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14
Q

describe the pulmonary involvement in RA

A
  1. occurs frequently
  2. pulmonary nodules
  3. interstitial lung disease happens in 7% of RA patients but they have a 3 fold increase in risk of death
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15
Q

Describe how RA is linked to cardiac disease

A
  1. RA may lead to generalised vascular disease or pericarditis
  2. CVD is common and risk of cardiac death is high
  3. important to treat risk- antiplatelets, statins, antihypertensives
  4. DMARD therapy significantly lowers risk
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16
Q

what is episcleritis

A

sudden onset of redness and pain

17
Q

describe the ocular involvement in RA

A
  • episcleritis and sicca syndrome is also common
18
Q

what is sicca syndrome

A

dry eyes due to inflamed tear ducts

19
Q

what are the genetic links in RA

A

many chronic inflammatory diseases have been shown to occur preferentially in individuals carrying certain variants of genes in the MHC

20
Q

describe the contribution of genetic factors to RA

A
  1. twin and family studies show contribution of genetic factors to RA
  2. HLA-DRB1 is the most likely genetic link
    - modified by smoking and other environmental factors
21
Q

how is rheumatoid factor linked to RA

A
  1. 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
  2. autoantibodies recognise antigens on IgG
  3. leads to complement fixation
22
Q

what does ACPA stand for

A

anti citrullinated peptide antibodies

23
Q

describe the role of ACPAs in RA

A
  1. RA patients have epitopes that come from citrulline, recognised by autoantibodies
  2. ACPA test is the way we check for these antibodies
  3. highly specific
24
Q

what are the 2 most common PIP/DIP deformities seen in RA? why is avoiding these deformities in particular, important in any treatment plan?

A
  1. swan neck deformity and boutonniere
  2. these deformities have a significant impact on a patients daily living and therefore significantly affect quality of life
  3. we want to try to avoid those at all costs because those are the goals that you want for any successful treatments

PY365 Autoimmune Cluster (19 decks)

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