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
