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38 Cards in this Set
- Front
- Back
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DEFINITION OF FULLY
DEVELOPED ARTHRITIS |
• Chronic, symmetrical, peripheral,
polyarthritis with subcutaneous nodules, erosion of joints and positive RF . • It is most frequent in women aged 40-60 |
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ACR 1987 Criteria for the Classification of
Acute Arthritis of Rheumatoid Arthritis A patient shall be said to have rheumatoid arthritis if he/she has satisfied at least 4 or these 7 criteria. Criteria 1 through 4 must have been present for at least 6 weeks. What are the 7 criterias? |
1. Morning stiffness lasting at least 1 hour
2. Arthritis of 3 or more joint areas 3. Arthritis of hand joints 4. Symmetric arthritis 5. Rheumatoid nodules 6. Serum rheumatoid factor 7. Radiographic changes |
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ARTICULAR
COMPLICATIONS of RA? |
• Subluxation
• Destruction • Ankylosis: fibrous bony • Infection |
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SYSTEMIC
COMPLICATIONSn of RA? |
1 Anaemia: of chronic disease
iron loss 2 Loss of weight 3 Amyloidosis: kidney, liver, gut 4 Felty’s syndrome (RA, splenomegaly and neutropaenia). 5 Increased mortality |
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EXTRA-ARTICULAR
COMPLICATIONS of RA? |
1 Nodules
3 Calf swelling 5 Renal 7 Respiratory 9 Ocular 2 Leg ulcers 4 Vasculitis 6 Neurological 8 Cardiac 10 Musculoskeletal |
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Rheumatoid nodules:
1. Prevalence 2. Sites 3. Complications |
1 In 20% RA, RF+++
2 Sites: extensor surfaces tendons organs 3 Complications: pain ulceration infection |
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EYE COMPLICATIONS in RA?
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1 Episcleritis
2 Scleritis 3 Nodule: scleromalacia perforans 4 Sjogren’s syndrome |
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Which HLA is associated with RA?
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HLA-DR1 and HLA-DR4
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What causes leg ulcers in RA?
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1 Vasculitic
2 Steroids and trauma 3 Felty’s syndrome |
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What causes swelling in RA?
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1 Ruptured knee joint
2 Ruptured Baker’s cyst 3 Deep vein thrombosis |
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MUSCULOSKELETAL
COMPLICATIONS in RA? |
1 Tendons: tenosynovitis
rupture 2 Osteoporosis due to: active disease steroids |
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NEUROLOGICAL
COMPLICATIONS in RA? |
• PERIPHERAL
Compression: median n ulnar n cervical nerves • CENTRAL Cord compression due to atlanto-axial subluxation |
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RENAL COMPLICATIONS in RA?
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Amyloidosis nephrotic syndrome
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RESPIRATORY
COMPLICATIONS in RA? |
1 Pleura: Nodules
Effusion 2 Lung: Interstitial lung disease Nodules Caplan’s Syndrome |
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CARDIAC
COMPLICATIONS in RA? |
1 Pericardial effusion
2 Constrictive pericarditis |
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What is rheumatoid factor and how coes it contribuitres to the pathogenesis or Rheumatoid Arthritis?
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Activated B-cells produce Ab. Rheumatoid factor is a
lgM autoantibody to the Fc portion of autologous lgG. Leads to formation of immune complexes. Important in further joint damage and extra-articular manifestations such as vasculitis. Present in 80% of RA patients and also in some otherwise healthy patients. Probably not critical to pathogenesis of disease. |
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What is them orphology of RA?
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Grossly involved synovium becomes oedematous and
thickened with a surface covering of fronds. Microscopically, the most striking feature is a dense infiltrate of lymphocytes, mainly CD4+ T cells. Lymphoid follicles may also form. Other morphological features include: A) Increased vascularity B) Surface fibrin deposition C) Surface neutrophil infiltrate D) Increased osteoclast activity in bone |
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Pannus is a feature of RA? What is it?
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Inflammatory fibrocellular mass of synovium synovial, stroma and
granulation tissue. Erodes into underlying cartilage and bone. May then bridge apposing bones forming a fibrous ankylosis. Eventually this may ossify. |
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List 3 conditions that causes seronegative inflammatory arthritides.
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psoriasis
reiter’s ankylosing spondylitis |
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Imaging in Rheumatoid Arthritis Hallmarks?
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• Soft tissue swelling
• Periarticular osteoporosis • Marginal erosions • Concentric joint space narrowing • Subchondral cysts • Proximal • Symmetrical • No osteophytes • No sclerosis |
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Imaging in Osteoarthritis
Hallmarks? |
• Sclerosis
• Osteophytosis • Joint space narrowing - weight bearing • Subchondral cyst / geode |
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Joint Deformities in rheumatoid arthritis?
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• Boutonnieres flexion PIP +extension DIP
• Swan neck hyperextension PIP + flexion DIP • Ulnar deviation fingers MCPJ • Radial deviation wrist radiocarpal articulation |
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List main features of juvenile rheumatoid arthritis.
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• Periosteal reaction proximal
phalanges/metacarpals • Joint ankylosis wrist/interphalangeal joints/ cervical spine • Early closure of growth plates • Overgrowth of epiphysis |
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What are the types of treatments that are avaialble in rheumatoid arthritis?
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• Drug Therapy
• Surgery • Physical Therapies – Occupational therapy – Physiotherapy – Podiatry • Psychosocial Aspects – Patient education – Psychological counselling – Social support |
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RHEUMATOID ARTHRITIS
Drug Treatment? |
• Analgesia
• NSAIDs (Non-steroidal anti-inflammatory drugs) • Steroids • DMARDs (Disease Modifying Anti-Rheumatic Drugs) • Biological Therapies (Anti-TNF, Il-1ra, anti-CD20) |
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List side effects of corticosteroids.
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• Musculoskeletal
–Myopathy –Osteoporosis – avascular necrosis • Cataracts • Hypertension • Fluid retention • Metabolic –Diabetes – Hyperlipidaemia –Obesity • Adrenal suppression • Impaired wound healing • Non-specific immunosuppression |
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List 4 commonly used DMARDs and 3 less commonly used
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Commonly Used
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METHOTREXATE in RA - action and side effects?
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• Weekly treatment
• Either oral/IM • Slows development of erosions • SIDE EFFECTS -Serious bone marrow supression liver toxicity pneumonitis teratogenic Non serious Mouth ulcers nausea/vomiting hair loss |
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Sulphasalazine use in RA and its side effects?
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• Twice a day dosing
• Oral • Slows development of erosions SIDE EFFECTS - Serious Bone marrow supression liver toxicity oligospermia Nonserious: - skin rash - nausea/vomiting |
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LEFLUNOMIDE use in RA and its side effects?
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• Developed specifically for RA
• Once daily dosing • Oral • Slows development of erosions Side effects Serious - bone marrow supression - liver toxicity - hypertension - ?Teratogenic Non serious - Nausea/Vomiting - Hair loss |
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Hydroxychloroquine in RA and its side effects?
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• Relatively safe
• Not very effective as single agent • Does not slow development of erosions • SIDE EFFECTS • Ophthalmic Toxicity – Maculopathy – Corneal opacities • Skin rashes – Can aggravate psoriasis |
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DMARD monitoring in RA?
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• Methotrexate, Sulphasalazine and Leflunomide
– Monthly FBC, LFTs, U+Es • Methotrexate – Baseline CXR • Leflunomide – Monitor BP • Hydroxychloroquine – Baseline and yearly reading charts. • NB: Pregnancy and Contraceptive advice. |
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List 3 anti-TNF alpha that is used to treat RA.
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Anti-TNFα
• Infliximab (IV infusion every 8 weeks) – Monoclonal antibody • Etanercept (sc injection twice/once a week) – Receptor fusion protein • Adalimumab (sc injection every 2 weeks) – Fully humanised monoclonal antibody |
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What's the nice indication for Anti-TNF alpha treatment of RA?
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–Active disease (DAS28>5.1)
– Failed 2 previous DMARDs (1 must be MTX) |
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What are the main side effets of anti-TNF alpha?
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- Infection, NB: reactivation of TB
–Worsening heart failure |
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List opioids used in chronic pain.
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Guidelines for the use of
opiates in chronic pain? |
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What is the mechanism of action of TC-antidepressants and its pharmacokinetics?
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