Rhuematoid Arthritis

Question 1

What is Ra?

Answer 1

A chronic autoimmune condition affecting the synovial joints and potentially other organs

Question 2

What are the risk factors/epidemiology of RA?

Answer 2

Females are more at risk due to less protein in their diet
Can start any age, most common 40/50
Genes e.g HLA DRB1 have been linked
Environmental factors e.g smoking, bacterial/viral triggers
Hormonal changes

Question 3

What are the clinical presentations of RA

Answer 3

Tender, warm, swollen joints
Joint stiffness and pain
Pain that worsens in the morning and after inactivity, more than 30 minutes
Pain in the same joints, both sides
40% experience symptoms that don’t include joints
Prolonged morning stiffness
Fatigue, fever and weight loss
Rheumatoid nodules

Question 4

Pathology of RA

Answer 4

Pannus formation, hyperplastic formation; tissue called pannus releases enzymes leading to cartilage damage. It invades and erodes the bone causing deformity.
Bone and joint erosion: inflammation leads to activation of osteoclasts, leads to resorption and erosion. Joint space narrows due to cartilage damage
Cytokinesis: pro inflammation cytokines TNF alpha, intervene driving inflammation and destruction

Question 5

Systemic effects of RA

Answer 5

-chronic inflammation affects other organs
-Cardiovascular system, increased role of arteriosclerosis
-Lungs , intestinal lung disease
- eyes,
- skin

Question 6

Ra differentia diagnosis

Answer 6

OA
Gout
Reactive arthritis
Ankylosing spondylitis

Question 7

Treatment of RA

Answer 7

Blood tests
Medications, nsaids, corticosteroids
Surgical: joint replacement
Non surgical, osteopathy