Rheumatoid Athritis Flashcards
What is rheumatoid arthritis
- A chronic auto immune systemic illness characterised by a symmetrical peripheral arthritis + other systemic features
- It is one of the commonest chronic illnesses + may be associated with joint damage, disability + premature mortality
4 parts of classification of RA
- Joint involvement
- Serology
- Acute-phase reactants
- Duration of symptoms
Describe the joint involvement part of classification
- 1 large joint (0)
- 2-10 large joints (1)
- 1-3 small joints (2)
- 4-10 small joints (3)
- > 10 joints [at least 1 small joint] (5)
Describe the serology part of classification
- Negative RF (0)
- Low-positive RF (2)
- High-positive RF (3)
Describe the acute-phase reactants part of classification
- Normal CRP/ESR (0)
- Abnormal CRP/ESR (1)
Describe the duration of symptoms part of classification
- < 6 weeks
- =/> 6 weeks
Ratio of female to male epidemiology
F:M = 3:1
Investigations for RA
Immunology
- Rheumatoid factor (IgG, IgM)
- Anti cyclic citrullinated antibodies
X-ray
Symptoms of RA
- Pain
- Stiffness
- Immobility
- Poor function
- Systemic symptoms
Clinical signs of RA
-Swelling tenderness
-Limited movement
(redness)
(heat)
What happens to the synovium, joint capsule and cartilage in RA
- Synovium = inflamed
- Joint capsule = Inflamed
- Cartilage = Destruction
3 types of systemic features of RA
- Non-specific
- Specific
- Long term
3 non specific features of RA
- Fatigue
- Weight loss
- Anaemia
5 specific features of RA
- Eyes
- Lungs
- Nerves
- Skin
- Kidneys
2 long term features of RA
- CVS
- Malignancy
How to assess RA
-Disease activity score
What autoantibodies are involved in RA
- RFs
- Anti-citrullinated protein
2 broad types of RA
- Seropositive RA
- Seronegative RA
what is rheumatoid factor (RF)
An auto-antibody to self IgG
Risk factors for RA
- Smoking
- EBV, CMV
- Periodontal disease (porphyromonas gingivalis)
4 types of treatment of RA
- Medicines
- Injections
- Therapies
- Surgery
4 therapeutic categories
- NSAIDs
- Disease modifying anti-rheumatic drugs (DMARD)
- Biologics
- Corticosteroids (oral, IM, IA)
2 DMARDs
- Methotrexate
- Sulfasalazine
What are DMARDs
- Group of structurally unrelated drugs
- Have been demonstrated to have a slow onset effect on disease activity
- And retard disease progression
Combination treatment of RA
Methotrexate + DMARD + biologic
Issues with biologics
-Efficacy, enhanced response when co-prescribed w/ methotrexate
-Cost (£9500 vs £50)
-Toxicity:
Minor = Injection site reaction
Infection
?Malignancy?
Describe the use of corticosteroid in RA Rx
- Can be prescribed PO, IA, IM, IV
- Short term benefit vs long term toxicity
- Rarely appropriate as single drug therapy
