Rheumatology

Question 1

Give some characteristics of RA

Answer 1

Polyarthritis
Inflammatory disorder
Affects small joints more than large
Generally affects joints symmetrically

Question 2

What affects does RA have on physiology?

Answer 2

Get inflammation of the synovial membranes and tendon sheaths.
Joints become swollen, tender and warm.
Stiffness limits movement
Get deformities and loss of function

Question 3

Give the characteristic signs of RA

Answer 3

Inflammation, stiffness, warmth and pain which lasts longer than one hour or after prolonged activity.
Movement can alleviate symptoms

Question 4

What are the three main deformities which can occur in the hands with RA?

Answer 4

Ulnar deviation
Swan neck deformity
Boutonniere deformity

Question 5

Give some systemic manifestations of RA

Answer 5

Pleural effusions, nodules and fibrosis
Renal impairment
Atherosclerosis
Pericarditis
Valvulitis
Anaemia
Fatigue

Question 6

Give the radiological features of RA on x-ray

Answer 6

Joint space narrowing
Periarticular osteopenia
Juxta-articular bony erosions
Subluxation
Gross deformity
Periarticular soft tissue swelling

Question 7

What blood tests would confirm a diagnosis of RA?

Answer 7

Rheumatoid factor

ACPAs (anti-citrullinated protein antibodies) - anti-CCP

Question 8

How does the American College of Rheumatology define RA?

Answer 8

1. Morning stiffness (>1 hour for 6 wks)
2. Arthritis of 3 joints
3. Arthritis of hand joints
4. Symmetrical arthritis
5. Rheumatoid arthritis
6. Positive rheumatoid factor
7. Radiographic changes (wrists, hands and feet)

Question 9

What is the management of RA?

Answer 9

Paracetamol or NSAIDs plus PPI
Urgent referral to rheumatologist
DMARDs 
Biologics
Can also use coxib is intolferant of NSAIDs

Question 10

What DMARDs are commonly used in RA?

Answer 10

Methotrexate
Asathioprine
Cyclosporin
Can take up to 3 months to have an effect

Question 11

What biologics are commonly used in RA?

Answer 11

Infliximab

Ethanecept

Question 12

How is disease activity measured?

Answer 12

ESR or CRP

Also need to measure factors for other organs to monitor extra-articular disease as well as monitoring drug treatments

Question 13

How is methotrexate given?

Answer 13

Weekly
Can be SC, IM or PO
Need to give daily folic acid to limit toxicity
Need to take an x-ray before commencing (pulmonary fibrosis)