Rheumatoid Arthritis Flashcards Preview

OSCE Conditions > Rheumatoid Arthritis > Flashcards

Flashcards in Rheumatoid Arthritis Deck (15):
1

Symptoms of RA

Joint pain - throbbing/aching pain, worse in mornings and after inactivity
Joint stiffness (worse in mornings), swelling, redness, tenderness
Commonly affects small joints of hands and feet, usually symmetrical
Tiredness, fever, reduced appetite

2

Risk factors for RA

Women
Smoking
Family history

3

Pathophysiology of RA

Chronic autoimmune inflammatory disease - type III hypersensitivity
Rheumatic factor binds to IgG receptors on macrophages leading to immune complex formation.
Release cytokines that cause inflammation of the synovial membrane, damages underlying cartilage

4

Investigations of RA

Bloods - FBC, CRP, rheumatoid factor, ANA assay
X-ray - hands, wrists, feet, etc
Joint aspiration and synovial fluid analysis

5

Management of RA

DMARDs eg. Methotrexate, sulfasalazine
Anti-TNF agents eg. Infliximab, Rituximab, Adalimumab
NSAIDs eg. Ibuprofen, naproxen
Corticosteroids

6

Mechanism of action of methotrexate

Inhibits purine metabolism, so increases adenosine levels, which acts on GPCRs to reduces T-cell activity

7

ADRs of methotrexate

ADRs: mucositis, bone marrow suppression, hepatitis, cirrhosis, increased infection risk, teratogenesis

8

Mechanism of action of sulfasalazine

Conjugate of Salicylate (5-ASA) and Sulfapyridine.
Sulfapyridine component allows absorbtion but also causes ADRs.
Salicylate is the active component, inhibits T-cell and IL-2 proliferation, reduces neutrophil chemotaxis and degranulation

9

Sulfasalazine ADRs

Myelosuppression, hepatitis, rash, nausea, fatigue, headache, abdominal pain

10

Mechanism of action of Anti-TNF agents

Block TNF-alpha with a monoclonal antibody, reduces inflammation, angiogenesis and joint destruction

11

Mechanism of action of NSAIDs

Competitive inhibitors of COX-1 and COX-2 enzymes, prevent prostaglandin synthesis from arachidonic acid

12

ADRs of NSAIDs

GI - stomach pain, nausea, heartburn, gastric ulcer/bleeding
Renal - reduced blood flow -> reduced GFR
Vascular - increased bruising, risk of haemorrhage
Skin rashes, Steven Johnson syndrome (rare)

13

Complications of RA

Carpal tunnel syndrome
Widespread inflammation -> pulmonary fibrosis, pericarditis, vasculitis
CVS disease

14

Signs of RA

Rheumatoid nodules

15

RA differential diagnosis

Osteoarthritis
SLE
Fibromyalgia
Sarcoidosis