Rheumatoid Arthritis

tomi1's version from 2017-01-30 18:53

Section 1

Question Answer
defineinflammatory autoimmue joint disease
which jointshands (MCP+wrist)-elbow-shoulder-hip-knee-ankle
genetic componentHLA-DR4 (80%)
prevelance RA3% population (mainly women)
pathology RAautoimmune response - inflammation synovial membrane-destroy cartilage- PANNUS
autoimmune feature RAIgM autoantibody against autologous IgG - immune complexes
pannusabnormal layer of granulation tissue-thickened synovium fluid
societal impact RA1/4 of work

Section 2

Question Answer
type of arthritis symmetrical polyarthritis
arthralgic symptomsSWELLING-stiffness-ROM
non-specific symptoms RApredate arthralgia= fatigue-myalgia-low grade fever
3 groups of symptomssystemic + articular + extra-articular
articular features RAhand-foot-cervical spine
extra-articular features RArheumatoid nodules-tenosynovitis-carpal tunnel syndrome
systemic featureseyes-skin-neuro-blood-spleen-lungs-heart
what group of people are systemic features more common inRF+ve

Section 3

Question Answer
hands articular features of RAswan (DIP flexion/PIPextension) + boutinnere deformity
foot artiuclar features RAforefoot synovitis (walk on marbles)
cervical spine features RAatalantoaxial sublaxation= cerviacal spine instability -excessive movement c1-c2
dangerous of cervical spine OASC COMPRESSION-atlas slips forward on axis
pre-op RA patients lateral spine XR/MRI - to check for cervical instability

Section 4

Question Answer
eyes RAdry eyes, episcleritism scleritis
skinrheumatoid nodules= firm SC nodules 20%
neurocarpal tunnel and periphral neuropathy
bloodNSAIDs=chronic blood loss GI inflammation
spleenFELTY SYNDROME: splenomegaly, leukopenia, RF+ve
lungspleural effusion, pulmonary fibrosis
heartpericarditis, coronay arteritis

Section 5

Question Answer
investigations RAbloods + XR
serology tests for RARF(normal in 5%pop) + anticyclic circullinated peptide antibodies
XR appearance RA periarticular OP- juxta-articular erosions- ST swelling- narrowing joint space
pathology RAactivated t cell-cytokines-RANK-osteoclast-inflammation/destruction

Section 6

Question Answer
management RAMDT-DMARDs-corticosteroids-biologics
names of DMARDmtx-sulfasalzine-hydroxychloroquine-leflunomide-gold
moa of DMARDslows disease progression
problem with DMARDslow acting (start 6 weeks after acute episode) + bone marrow suppression
MDT for RA Rheum-specialist nurse- orthopaedic surgeon-physio-OT-podiatrist
acute management of RAlow dose prednisolone

Section 7

Question Answer
SE of MTXdiarrhoea,ulcers,lfts,bm suppression
SE of sulfaslasinediarrhoea,lfts,bm supression
SE of hydroxychloroquineretinal damage
SE of leflunomide HTN-diarrhoea-BM suppression
SE of gold rash-proteinuria-bm suppression

Section 8

Question Answer
targets of biologicsT cell-B cell-macrophages
moa abataceptprevents T cells
moa etanercet,infliximab,adalimumabprevents tnf-a
moa andakinraprevents IL-1
moa tocilizumabprevents IL6R
moa rituximabprevents CD20