Rhuematoid Arthritis

Question 1

Aetiology and epidemiology RA

Answer 1

Genetic
Environmental - smoking, infection
F > M 2:1
5th - 6th decade

Question 2

Pathophysiology RA

Answer 2

Synovitis, rheumatoid factor from plasma cells, synovial thick, increased polymorphs, vascular proliferation and permeability leads to effusion
Decreased cartilage goes to bone exposed
B-cell pathway causes vasculitis, inflammation and erosion
T-cell pathway erosion, bursa swelling, tendon sheath swelling

Question 3

Symptoms and signs RA

Answer 3

Swelling, tenderness, redness, heat, limitation of movement, pain, immobility, stiffness, poor function, systemic symptoms (fatigue, weight loss, anaemia)
Morning stiffness > 1hr, symmetrical swelling,

Question 4

Investigations RA

Answer 4

Rheumatoid factor, increased CRP and ESR,
X-rays - soft tissue in early stages (junta-articular osteopenia, decreased joint space)
Aspiration of joint (cloudy due to WBC)
ANCA, anti-ccp and ACPA
FBC

Question 5

DDx of RA

Answer 5

OA
Viral arthritis
Connective tissue disease

Question 6

Assessment of RA

Answer 6

Disease activity score (how many joints, ESR or CRP, visual analogue)
DAS < 2.4 = clinical remission
DAS > 5.1 = biologic therapy eligible

Question 7

Management of RA

Answer 7

DMARDs 
Corticosteroids
Surgery
Physio
OT
NSAIDs
Biologics

Question 8

DMARDs

Answer 8

Slow onset effect on disease activity

Methotrexate, sulfasalazine, Hydroxychloroquine

Question 9

Corticosteroids in RA

Answer 9

Oral, IA, IM or IV infusion
Acute exacerbations
Avoid long term

Question 10

Biologics in RA

Answer 10

Target key aspects of inflammation cascade
Given parenterally
Rapid and generally well tolerated
TNF-alpha inhibitors
Anti-B cell (rituximab)