Rheumatology 2 - Rheumatoid Arthritis Flashcards

1
Q

define rheumatoid arthritis

A

chronic autoimmune symmetrical polyarthritis

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2
Q

Abs + gene assoc Rheum Arth

A

HLA DR4

RF
anti CCP

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3
Q

presentation of rheumatoid arthritis

A
pain swelling stiffness
symmetrical distal polyarth
fatigue
weight loss
muscle aches
flu prodrome
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4
Q

define palindromic rheumatism

A

self-limiting short episodes of inflammatory arthritis in a few joints

1-2 days then resolve

may progress later

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5
Q

key joints affected in rheumatoid arthritis + one set that never are

A

proximal interpharyngeal
metacarpophalangeal
cervical spine

never DIP (distal interpharyngeal joints)

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6
Q

tell me about atlantoaxial subluxation and where relevant

A

in rheumatoid arthritis

cervical spine subluxation at c1,c2

risk of spinal cord compression

must have MRI check before any anaesthetic

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7
Q

4 hand signs for rheumatoid arthritis

A

Z shaped thumb deformity
swan neck deformity
Boutonniere’s deformity
ulnar deviation

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8
Q

4 key extra-articular manifestations of rheumatoid arthritis

A

pulmonary fibrosis
bronchiolitis obliterans
Felty’s syndrome (RA + neutropaenia + splenomegaly)
secondary Sjogren’s

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9
Q

investigating rheumatoid arthritis

A

check RF, ESR, CRP first
if negative, check CCP
x ray hands + feet
ultrasound if unsure of synovitis

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10
Q

x ray changes in rheumatoid

A

joint destruction/ deformity
swelling
periarticular osteopenia
bony erosions

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11
Q

when to refer for rheumatology

A

any adult with persistent synovitis even with negative bloods

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12
Q

diagnostic score for rheumatoid

A

ACR/ELAR score

score of 6+

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13
Q

disease severity score for rheumatoid

A

DAS28

assess 28 joints

looks at response to treatment

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14
Q

management steps for rheumatoid

A

1 of - methotrexate, leflunomide, sulphasalazine, hydroxychloroquine
2 - 2 in combo
3 - methotrexate + TNFblock
4 - methotrexate + rituximab

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15
Q

main biologics to be aware of in rheumatoid

A

anti-TNF - adalimumab, infliximab, entanercept, tocilizumab

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16
Q

key things to know about methotrexate incl side effects

A

must have weekly folic acid on a different day to the methotrexate

SEs: pulmonary fibrosis, teratogenic, ulcers, heptox,

17
Q

key things to know about leflunomide incl side effects

A

interferes with pyrimidine

SEs: peripheral neuropathy
teratogenic

18
Q

key things to know about sulphasalazine incl side effects

A

can be used in pregnancy with folic acid supplements

SE: temporary male infertility

19
Q

key things to know about hydroxychloroquine incl side effects

A

interferes with TLRs

SEs: nightmares, macular toxicity, skin pigmentation

20
Q

key things to know about anti-TNF drugs incl side effects

A

‘cept binds TNF to IgG Fc portion

SEs: reactivation of TB or hepatitis B

21
Q

key things to know about rituximab incl side effects

A

targets CD20 on B cells

SEs: night sweats, low platelets, peripheral neuropathy