Rheumatology - Rheumatoid Arthritis Flashcards

1
Q

What are the risk factors for rheumatoid arthritis?

A

Women
Middle age
Smoking
Obesity
HLADR4 gene

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2
Q

What antibodies are present in RA?

A

Rheumatoid factor
Anti-CCP

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3
Q

Where does the rheumatoid factor autoantibody target?

A

Fc portion of IgG

Causes immune activation against IgG

Most often IgM

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4
Q

What antibody is more specific and sensitive?

A

Anti-CCP

Often present before patient affected by RA

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5
Q

How does RA present?

A

Pain
Stiffness
Swelling

Symmetrical distal polyarthritis

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6
Q

What joints are most affected in RA?

A

MCP
PIPs
Wrist
MTP

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7
Q

What is present on palpation of joints affected by RA?

A

Tenderness
Synovial thickening

Boggy feeling

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8
Q

What are the hand signs in RA?

A

Z-shaped deformity
Swan neck deformity
Boutonniere deformity
Ulnar deviation

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9
Q

What causes boutonniere deformity?

A

Tear in central slip of extensor components at PIP

Central slip connects middle phalanx to PIP

Lateral bands go around PIP and connect to distal phalanx

Hyperextension of DIP
Flexion of PIP

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10
Q

What causes swan neck deformity?

A

Tear of central slip in flexor

Hyperflexion of DIP
Extension of PIP

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11
Q

What are some extra-articular manifestations of RA?

A

Episcleritis
Keratitis
Cataracts
Retinopathy
Felty’s syndrome
Anaemia of chronic disease
Carpal tunnel syndrome

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12
Q

What is atlantoaxial subluxation?

A

Synovitis and damage to ligaments around the peg

Can cause spinal cord compression

MRI

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13
Q

How is RA diagnosed?

A

RF
Anti-CCP
CRP and ESR
X-rays
USS or MRI to detect synovitis

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14
Q

What are the x-ray changes of RA?

A

Periarticular osteopenia
Boney erosions
Soft tissue swelling
Joint destruction and deformity

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15
Q

What scoring systems are used for RA?

A

HAQ
Disease Activity Score 28 joints

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16
Q

What is used to monitor treatment of RA?

A

CRP
DAS28

17
Q

What can be used at initial presentation of RA?

A

Short-term steroids

18
Q

How is RA treated?

A
  1. Monotherapy with methotrexate, leflunomide or sulfasalazine
  2. Combination treatment with multiple cDMARDS
  3. Biologic therapies alongside methotrexate
19
Q

What happens to RA in pregnancy?

A

Can improve symptoms

Some women may get a symptom flare

Hydroxychloroquine and sulfasalazine can be used in pregnancy

Folic acid is required with sulfasalazine

20
Q

What are the different categories of biological DMARDS?

A

TNF inhibitors
- Infliximab
- Adalimunab

Anti-CD20 on B cells
- Rituximab

21
Q

What are the main side effects of :
- Methotrexate
- Leflunomide
- Sulfasalazine
- Hydroxychloroquine
- Anti-TNF medications
- Rituximab

A

Methotrexate
Interferes with folate metabolism
Need once weekly folic acid 5mg

  • Bone marrow suppression and leukopenia

Leflunomide
Interferes with production of pyrimidine

  • Hypertension and peripheral neuropathy

Sulfasalazine
- Orange urine
- Reduces sperm count

Hydroxychloroquine
Targets Toll-like receptors disrupting antigen presentation and increasing pH in lysosomes

  • Retinal toxicity
  • Blue-grey skin pigmentation
  • Hair bleaching

Anti-TNF
- Reactivates TB

Rituximab
- Night sweats
- Thrombocytopenia