Clinical Aspects of Rheumatoid Arthritis Flashcards Preview

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Flashcards in Clinical Aspects of Rheumatoid Arthritis Deck (13)
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1

What is the definition of rheumatoid arthritis?

Rheumatoid Arthritis is a chronic auto immune systemic illness characterised by a symmetrical peripheral arthritis and other systemic features

2

What may rheumatoid arthritis be associated with?

-Joint damage
-Disability
-Premature mortality

3

What is the ARA criteria for rheumatoid arthritis?

-Morning stiffness
-Arthritis of 3 or more joint areas
-Arthritis of hand joints
-Symmetric arthritis
-Rheumatoid nodules
-Serum rheumatoid factor
-Radiographic changes

4

What is the prevalence and incidence of RA?

Prevalence
-Approx 1% of population

Incidence
-Approx 200 ne cases per year in Grampian

5

Who gets RA?

-F:M 3:1
-Peak age of onset in 4th/5th decase but may occur at any age from 16 years

6

What is the aetiology of RA?

Genetics
-Link with siblings in particular monozygotic twins
-Genetic contribution estimated to be 50-60%
-Closest association with specific amino acid sequences at positions 70-74 of DRB1 (sheared epitope)

Environment
-Cigarette smoking
-Chronic infection e.g periodontal disease

7

What is the pathogenesis of RA?

Cartilage thinning

Inflamed synovial membrane

Pannus (abnormal layer of fibrovascular/ granulation tissue)
-Major cell types: T lymphocytes and macrophages
-Minor cell types: fibroblasts, plasma cells, endothelium dendritic cells

Synovial fluid
-Major cell type: neutrophils

8

How is RA investigated?

Immunology
-Rheumatoid factor (IgG, IgM)
-Anti Cyclic Citrullinated Antibodies (anti CCP, ACPA)

Radiology

9

What are the symptoms of RA?

-Pain
-Stiffness
-Immobility
-Poor function
-Systemic Symptoms

10

What are the clinical signs of RA?

-Swelling
-Tenderness
-Limitation of movement
-Redness
-Heat

11

What are the systemic features of RA?

Non-specific
-Fatigue/lassitude
-Weight loss
-Anaemia

Specific
-Eye problems
-Lung issues
-Nerve issues
-Skin problems
-Kidney problems

Long term
-CVS risk
-Malignancies

12

How is RA assessed?

Disease activity score
- DAS<2.4 represents clinical remission
-DAS>5.1 represents eligibility for biologic therapy

13

What are the outcomes of RA?

-75% of cases diagnosed during working life
-Approx 33% will have stopped working within 2 years
-Approx 50% will be unable t0 work due to disability within 10 years of diagnosis
-A person with RA will have, on average 40 days sick leave/year (compared with 6.5)