Rheumatology 2 - Rheumatoid Arthritis Flashcards
define rheumatoid arthritis
chronic autoimmune symmetrical polyarthritis
Abs + gene assoc Rheum Arth
HLA DR4
RF
anti CCP
presentation of rheumatoid arthritis
pain swelling stiffness symmetrical distal polyarth fatigue weight loss muscle aches flu prodrome
define palindromic rheumatism
self-limiting short episodes of inflammatory arthritis in a few joints
1-2 days then resolve
may progress later
key joints affected in rheumatoid arthritis + one set that never are
proximal interpharyngeal
metacarpophalangeal
cervical spine
never DIP (distal interpharyngeal joints)
tell me about atlantoaxial subluxation and where relevant
in rheumatoid arthritis
cervical spine subluxation at c1,c2
risk of spinal cord compression
must have MRI check before any anaesthetic
4 hand signs for rheumatoid arthritis
Z shaped thumb deformity
swan neck deformity
Boutonniere’s deformity
ulnar deviation
4 key extra-articular manifestations of rheumatoid arthritis
pulmonary fibrosis
bronchiolitis obliterans
Felty’s syndrome (RA + neutropaenia + splenomegaly)
secondary Sjogren’s
investigating rheumatoid arthritis
check RF, ESR, CRP first
if negative, check CCP
x ray hands + feet
ultrasound if unsure of synovitis
x ray changes in rheumatoid
joint destruction/ deformity
swelling
periarticular osteopenia
bony erosions
when to refer for rheumatology
any adult with persistent synovitis even with negative bloods
diagnostic score for rheumatoid
ACR/ELAR score
score of 6+
disease severity score for rheumatoid
DAS28
assess 28 joints
looks at response to treatment
management steps for rheumatoid
1 of - methotrexate, leflunomide, sulphasalazine, hydroxychloroquine
2 - 2 in combo
3 - methotrexate + TNFblock
4 - methotrexate + rituximab
main biologics to be aware of in rheumatoid
anti-TNF - adalimumab, infliximab, entanercept, tocilizumab
key things to know about methotrexate incl side effects
must have weekly folic acid on a different day to the methotrexate
SEs: pulmonary fibrosis, teratogenic, ulcers, heptox,
key things to know about leflunomide incl side effects
interferes with pyrimidine
SEs: peripheral neuropathy
teratogenic
key things to know about sulphasalazine incl side effects
can be used in pregnancy with folic acid supplements
SE: temporary male infertility
key things to know about hydroxychloroquine incl side effects
interferes with TLRs
SEs: nightmares, macular toxicity, skin pigmentation
key things to know about anti-TNF drugs incl side effects
‘cept binds TNF to IgG Fc portion
SEs: reactivation of TB or hepatitis B
key things to know about rituximab incl side effects
targets CD20 on B cells
SEs: night sweats, low platelets, peripheral neuropathy
