Rheumatology Flashcards
Who are the team involved in managing in rheumatoid arthritis?
GP Consultant Physiotherapy Occupational therapy Social work Specialist nurse Pharmacist Clinical psychologist Podiatrist Orthotics Orthopaedic surgeon
What are the key pharmacological interventions in inflammatory arthritis?
Therapeutic categories
- NSAIDs
- disease modifying anti rheumatic drugs DMARDs eg methotrexate, sulfaslazine
- Biologics eg TNF alpha inhibitors, IL-1 inhibitors
- Corticosteroids (oral, IM, IA)
Early and aggressive treatment is key
What is the prevalence, presentation, diagnosis and clinical manifestation of rheumatoid arthritis?
Prevalence: 1% of population, approx 200 new cases in Grampian, F>M
Presentation: morning stiffness, arthritis in >3 joints, arthritis of hands, symmetric arthritis, rheumatoid nodules, serum rheumatoid factor, radiographic changes,
Symptoms: pain, stiffness, immobility, poor function, systemic symptoms (fatigue, weight loss, anaemia, specific such as eyes, lung signs)
Signs: swelling, tenderness, limited movement
Diagnosis: history + exam + investigations (rheumatoid factor, anti cyclic citrullinated antibodies, x ray, uss
Assess: disease activity score <2.4 = clinical remission, >5.1 = eligible for biologic therapy
What is rheumatology?
Medical specialty which deals with arthritis (inflammation of joint/joints) and this includes rheumatoid arthritis, seronegative arthritis, crystal arthritis, connective tissue diseases, systemic vasculitis, bone disease, osteoarthritis
What is rheumatoid arthritis?
Chronic symmetric polyarticular inflammatory joint disease, primarily small joints of hands and feet Rheumatoid synovitis (pannus) is characterised by inflammatory cell infiltration, synoviocyte proliferation and neoangiogenesis Fluid contains neutrophils Pannus causes bone and cartilage destruction (joint space narrowing and erosions)
Autoimmune:
Seropositive (has rheumatoid factor, anti citrullinated protein antibody) or seronegative RA (normal factors)
