Rheunatoid arthritis clinical

Question 1

What is it?

Answer 1

• A Chronic, auto immune, systemic illness characterised by a symmetrical peripheral arthritis and other systemic features
• Associated with joint damage, disability and premature mortality

Question 2

Epidemiology

Answer 2

• More common in females : 3: 1
• Most common in 4th/5th decade of life
• 1% of the population

Question 3

Aetiology

Answer 3

• Genetic: increased risk in siblings and twins

- Environmental: smoking and chronic infection increase risk

Question 4

Investigation

Answer 4

Blood tests
Imaging: 
-Xray
-MRI
-Ultrasound 
-Radionuclide

Question 5

what blood tests are done?

Answer 5

• RhF: rheumatoid factor will be positive in about 70% of patients
• Anti-CCP: anti citrullinated peptide antibodies very specific – help assess progress of disease
• Increased platetes
• Increased CRP/ESR

Question 6

Symptoms

Answer 6

• Morning stiffness
• Swelling ( tends to be symmetrical)
• Pain
• Immobility
• Systemic features

Question 7

Systemic features

Answer 7

a) Non-specific:
- Fatigue/lassitude
- Weight loss
- Anaemia

b) Specific
-Eyes: Scleritis, episcleritis, scleromalacia
-Lungs: Pleural disease, intersistial fibrosis
Nerves
Skin: nodules
Kidneys
c) Long term: CVS, Malignancy

Question 8

How to assess how bad disease is?

Answer 8

DISEASE ACTIVITY SCORE (DAS-28)

Assess tenderness and swelling in all 28 joints

Question 9

Outcome for patients?

Answer 9

o 50% of patients dead or disabled within 20 years of diagnosis (1987)
o 50% out of workplace within 2 years of diagnosis

Question 10

Management

Answer 10

• DMARD
• NSAIDs: good a short term relief but do not affect progression
• Biologics
• Corticosteroids

Question 11

What are DMARDs?

Give examples

Answer 11

Disease modifying anti rheumatic drugs
A group of structurally unrelated, typically small molecule drugs which have been demonstrated to have slow onset effect on disease activity and retard disease progression. Traditionally, these have been associated with identifiable toxicity profiles and risk of occasional serious adverse event.
• Methotrexate
• Sulfasalazine

Question 12

What are biologics and pros and cons?

Answer 12

• Target specific inflammatory cascade reactions
• Usually large proteins which need to be given parenterally

Pros: work very rapidly and are well tolerated
Cons:have high costs

Question 13

Examples of biologics

Answer 13

• TNFa inhibitors (x5)
• IL-1 inhibitors (Anakinra)
• Anti B Cell therapies (CD20, Rituximab)
• Anti T Cell therapies (Abatacept)
• IL-6 inhibitors (Tocilizumab)
• Other

Question 14

other management:

Answer 14

• Physio

- Surgery