Rheumatoid Arthritis Flashcards Preview

MD2 Ambulatory Care and Emergency Medicine > Rheumatoid Arthritis > Flashcards

Flashcards in Rheumatoid Arthritis Deck (23)
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1
Q

What is the classic age for rheumatoid arthritis?

A

30s - most people with inflammatory conditions are younger

2
Q

What is the pattern for inflammatory arthritis?

A

Peripheral, symmetrical, polyarthritis

3
Q

What are the differential diagnoses for rheumatoid arthritis?

A

Psoriatic arthritis
Post-infective arthritis
Lupus, especially if symptoms affecting other systems present

4
Q

What are the symptoms of mechanical joint pain?

A
Chronic pain = months-years
Slowly worsening
Worse with movement
Improved by rest
Not much swelling
Little stiffness = 10-15 mins
5
Q

What are the symptoms of inflammatory joint pain?

A

Acute/subacute pain
May worsen quickly
Better after movement
Worse after rest
Swelling often noticeable and may be prominent
Stiffness may be prolonged (hours) and worse in morning

6
Q

Which joint is usually first to be affected in rheumatoid arthritis?

A

2nd metacarpo-phalangeal (MCP) joint

7
Q

Which joints are usually affected in rheumatoid arthritis?

A
Proximal interphalangeal (PIP) joints of hands
MCP joints
Joints of wrist
Elbow joints
Acromioclavicular (AC) joints
Cervical spine
Hips
Knees
Metatarsophalangeal (MTP) joints
PIP joints of feet
8
Q

What are the risk factors for rheumatoid arthritis?

A

Family history

Smoking

9
Q

What is the role of pregnancy in rheumatoid arthritis?

A

Pregnancy protective

Post-childbirth causes flare

10
Q

What are the signs of rheumatoid arthritis?

A

Affected joints

  • Puffy and swollen
  • Tender
  • Range of movement can be affected
11
Q

Can larger joints be affected in rheumatoid arthritis?

A

Yes, they can, but usually later on in disease

12
Q

Which joints are usually affected in osteoarthritis?

A
1st carpo-metacarpal (MCP) joints
Distal interphalangeal (DIP) joints of hands
AC joints
Cervical spine
Lumbar spine
Hips
Knees
1st tarso-metatarsal (TMT) joints
13
Q

What investigations are useful in rheumatoid arthritis?

A

Ultrasound and MRI useful in early presentation for picking up subclinical synovitis
Also useful in monitoring treatment
Ultrasound used more often than MRI due to access and expense

14
Q

What is the utility of measuring anti-citrullinated protein antibody (ACPA) and rheumatoid factor?

A

Very relevant for prognosis

Diagnostic value lower

15
Q

What are the treatment goals for rheumatoid arthritis?

A
Reduction of joint inflammation
Prevention of joint damage
Prevention of long-term associated complications
Avoid drug complications
Maintenance of quality of life
16
Q

How and why is remission aimed for in the treatment of rheumatoid arthritis?

A

Early aggressive treatment > remission ASAP
If you can get patient into remission for 1st 6 months, their prognosis much better, as a lot of erosive damage will occur within this time

17
Q

What are the pharmacological therapies available for rheumatoid arthritis?

A

NSAIDs
Disease modifying anti-rheumatic drugs (DMARDs)
Corticosteroids
Analgesics

18
Q

What is the first line DMARD used?

A

Methotrexate

19
Q

What is the efficacy of NSAIDs in the treatment of rheumatoid arthritis?

A

Good short- and long-term efficacy

20
Q

What are the biologic DMARDs available?

A

TNF inhibitors - mainstay of treatment
B cell inhibitor
Cell adhesion inhibitor
IL-6 inhibitor

21
Q

How does the route of administration of corticosteroids affect their efficacy and side effects?

A
Oral prednisolone
- Efficacious
- Side effects
   - Hypertension
   - Weight gain
   - Skin changes
   - Hyperglycaemia
   - Osteoporosis
Intra-articular steroids
- Efficacious in accessible joints
- Few side effects if used intermittently
22
Q

How is disease activity measured in rheumatoid arthritis?

A
Patient and physician global assessment
Swollen and tender joint count O/E
Measures of inflammation
- CRP
- ESR
23
Q

How is disease damage measured in rheumatoid arthritis?

A

Bone and cartilage damage slower than soft tissue swelling
MRI more sensitive than x-ray for detecting
- Synovitis
- Cartilage damage
- Bone oedema
- Bone erosions
X-rays usually not needed in early management