Shared Flashcard Set

Details

CC12 - Rheumatoid Arthritis
RA relating to rheum and ortho.
130
Medical
Undergraduate 1
05/24/2015
Click here to study/print these flashcards.

Create your own flash cards! Sign up here.

Additional Medical Flashcards

 

 

Cards

Term
What is RA characterised by?
 Definition
Symmetrical polyarticular athritis, usually involving the hands, following a chronic course, that can result in significant disability.
Term
After 20 years, what proportion of those with RA have some disability?
 Definition
80%
Term
Which gender is affected more by RA?
 Definition
Females
Term
What is the aetiology of RA.
 Definition
It is unexplained, however it appears to be multifactorial, with both genetic and environmental factors.
Term
What does HLA stand for?
 Definition
Human Leukocyte Antigen
Term
What region of DNA has genes that have been linked to RA?
 Definition
HLA DR4
Term
Give an environmental factor that is known to have an association with more aggressive RA.
 Definition
Smoking
Term
What cells play a key role in initiating the inflammation in RA?
 Definition
T lymphocytes.
Term
Give 7 actions of cytokines in RA.
 Definition
Activation of RA.
Attraction of other immune cells.
Excess synovial fluid production
Cartilage destruction
Bone resorption
Stimulation of B-lymphocyte differentiation and maturation
Increased antibody production, including production of rheumatoid factor.
Term
Name 2 cytokines produced in RA.
 Definition
TNF-alpha
IL-1
Term
What does TNF stand for?
 Definition
Tumour necrosis factor
Term
What does IL-1 stand for?
 Definition
Interleukin-1
Term
What cells produce RF and anticitrullinated protein antibodies, and where?
 Definition
Activated B-lymphocytes, in the synovium.
Term
What is the main pathological abnormality in RA?
 Definition
Synovitis.
Term
What cells produce chronically inflamed tissue in RA?
 Definition
Macrophages and osteoclasts.
Term
In RA, what errodes the articular cartilage?
 Definition
Chronically inflammed tissue.
Term
What is pannus?
 Definition
Chronically inflamed tissue.
Term
In RA, what leads to joint deformity?
 Definition
Extensive erosion of cartilage and bone.
Term
What commonly happens to entheses in RA?
 Definition
They become inflamed.
Term
Above what age can RA develop?
 Definition
0, RA can develop at any age.
Term
What decades does RA peak in prevalence?
 Definition
40 and 50.
Term
Do symptoms of RA normally develop quickly or gradually?
 Definition
Gradually.
Term
What are the three usual presenting symptoms of RA?
 Definition
Joint pain, stiffness and swelling.
Term
When is stiffness in RA usually worst?
 Definition
In the mornings.
Term
Does RA commonly affect the hip?
 Definition
No.
Term
Describe the swelling caused by synovitis.
 Definition
Boggy.
Term
What is the swelling of synovitis of similar consistency to?
 Definition
A grape.
Term
How urgently does a need to refer a patient with RA to a specialist, in weeks?
 Definition
Within 6 weeks of symptom onset..
Term
In the hand, which joints are usually spared in RA?
 Definition
DIP
Term
Which joints in the hand are commonly affected by RA?
 Definition
PIP and MCP
Term
Synovitis of which joint results in ulnar deviation?
 Definition
MCP
Term
Synovitis and laxity of which joint results in boutonier deformities?
 Definition
PIP
Term
Synovitis and laxity of which joint results in swan-neck deformities?
 Definition
PIP
Term
What is boutoniere deformity characterised by?
 Definition
PIP flexion and DIP hyperextension
Term
What is swan-neck deformity characterised by?
 Definition
MCP flexion, PIP hyperextension and DIP flexion.
Term
Why does radial deviation of the wrist occur in RA?
 Definition
To compensate for the ulnar deviation of the fingers.
Term
In RA, what do the proximal phalanges?
 Definition
They sublux dorsally.
Term
In RA, what happens to the metatarsal heads?
 Definition
They become eroded and displaced towards the floor.
Term
What do patients with established RA develop at the subtalar joint?
 Definition
Valgus deformities.
Term
In RA, what can result in atlantoaxial subluxation?
 Definition
Inflammation and erosive disease, affecting the first cervical vertebrae and the stabilising ligaments of the first two cervical vertebrae.
Term
In RA, what is caused by Inflammation and erosive disease, affecting the first cervical vertebrae and the stabilising ligaments of the first two cervical vertebrae?
 Definition
Atlantoaxial subkuxation
Term
What happens in Atlantoaxial subkuxation?
 Definition
The atlas slips forward on the axis, reducing the space around the spinal cord, producing neck pain that radiates from the occiput.
Term
What is a rare complication of Atlantoaxial subkuxation?
 Definition
Upper motor neuron damage, resulting in a spastic quadriparesis.
Term
In RA, what can lead to sudden death from a minor jolt to the head and neck?
 Definition
Damage the articulation between the occiput and the atlas, allowing the odontoid peg to move upwards through the foramen magnum, threatening the cervical cord and brain stem.
Term
In RA patients requiring a general anaesthetic, what imaging is required?
 Definition
A lateral flexion x-ray or MRI.
Term
What percentage of patients with RA have rhuematoid nodules?
 Definition
20%
Term
Where do rheumatoid nodules tend to develop?
 Definition
Areas affected by pressure or friction, such as the fingers, elbows and achilles tendon.
Term
What can rheumatoid nodules be complicated by?
 Definition
Infection.
Term
Give three extra-articular features of RA
 Definition
Rheumatoid Nodules
Tenosynovitis and bursitis
CTS
Term
What is the swelling of synovitis of similar consistency to?
 Definition
A grape.
Term
How urgently does a need to refer a patient with RA to a specialist, in weeks?
 Definition
Within 6 weeks of symptom onset..
Term
In the hand, which joints are usually spared in RA?
 Definition
DIP
Term
Which joints in the hand are commonly affected by RA?
 Definition
PIP and MCP
Term
Synovitis of which joint results in ulnar deviation?
 Definition
MCP
Term
Synovitis and laxity of which joint results in boutonier deformities?
 Definition
PIP
Term
Synovitis and laxity of which joint results in swan-neck deformities?
 Definition
PIP
Term
What is boutoniere deformity characterised by?
 Definition
PIP flexion and DIP hyperextension
Term
What is swan-neck deformity characterised by?
 Definition
MCP flexion, PIP hyperextension and DIP flexion.
Term
Why does radial deviation of the wrist occur in RA?
 Definition
To compensate for the ulnar deviation of the fingers.
Term
In RA, what do the proximal phalanges?
 Definition
They sublux dorsally.
Term
In RA, what happens to the metatarsal heads?
 Definition
They become eroded and displaced towards the floor.
Term
What do patients with established RA develop at the subtalar joint?
 Definition
Valgus deformities.
Term
In RA, what can result in atlantoaxial subluxation?
 Definition
Inflammation and erosive disease, affecting the first cervical vertebrae and the stabilising ligaments of the first two cervical vertebrae.
Term
In RA, what is caused by Inflammation and erosive disease, affecting the first cervical vertebrae and the stabilising ligaments of the first two cervical vertebrae?
 Definition
Atlantoaxial subkuxation
Term
What happens in Atlantoaxial subkuxation?
 Definition
The atlas slips forward on the axis, reducing the space around the spinal cord, producing neck pain that radiates from the occiput.
Term
What is a rare complication of Atlantoaxial subkuxation?
 Definition
Upper motor neuron damage, resulting in a spastic quadriparesis.
Term
In RA, what can lead to sudden death from a minor jolt to the head and neck?
 Definition
Damage the articulation between the occiput and the atlas, allowing the odontoid peg to move upwards through the foramen magnum, threatening the cervical cord and brain stem.
Term
In RA patients requiring a general anaesthetic, what imaging is required?
 Definition
A lateral flexion x-ray or MRI.
Term
What percentage of patients with RA have rhuematoid nodules?
 Definition
20%
Term
Where do rheumatoid nodules tend to develop?
 Definition
Areas affected by pressure or friction, such as the fingers, elbows and achilles tendon.
Term
What can rheumatoid nodules be complicated by?
 Definition
Infection.
Term
Give three extra-articular features of RA
 Definition
Rheumatoid Nodules
Tenosynovitis and bursitis
CTS
Term
Which tendons are often affected by tenosynovitis in RA?
 Definition
The flexor tendons of the fingers.
Term
Which bursae are commonly affected by bursitis in RA?
 Definition
The olecranon and subacromial bursae.
Term
What are the flexor tendons of the fingers often affected with in RA?
 Definition
Tenosynovitis.
Term
WHat affect can RA have on peripheral nerves?
 Definition
The synovitis of RA can cause entrapment of peripheral nerves.
Term
Give 3 systemic symptoms of the inflammation of RA.
 Definition
Fever, weight loss, lethargy.
Term
Give three ways in which RA can affect the lungs.
 Definition
Pleural effusions
Lung nodes
Pulmonary fibrosis
Term
Give three ways in which RA can affect the eyes.
 Definition
Keratoconjuntivitis sicca
Episcleritis
Scleritis
Term
Give one way in which RA can affect the kidneys.
 Definition
Amyloidosis.
Term
Give one way in which RA can affect the spleen.
 Definition
Felty syndrome.
Term
Give three ways in which RA can affect the heart.
 Definition
Pericarditis
Myocarditis
Coronary arteritis.
Term
Give 5 ways in which RA can produce anaemia.
 Definition
Anaemia of chronic disease
Autoimmune haemolysis
Felty Syndrome
NSAID anaemia due to GI inflammation
DMARDs causing bone marrow suppression.
Term
What is Felty syndrome?
 Definition
The association of RA with splenomegaly and leukopenia.
Term
What RA patients if Felty usually found in?
 Definition
Those who are rheumatoid factor positive.
Term
Which gender is more commonly affected by Rheumatoid lung disease?
 Definition
Males.
Term
In which patients with RA are lung nodules found in?
 Definition
THose who are seropositive, and usually have subcutaneous nodules.
Term
In RA, what can lead to pulmonary fibrosis?
 Definition
Pneumonitis
Term
What three findings may suggest RA in a full blood count?
 Definition
Anaemia of chronic disease
THrombocytosis secondary to inflammation
Leukopenia of Felty syndrome.
Term
What are normally raised in synovitis?
 Definition
ESR and CRP
Term
What is the term for those with RA but lacking in RF?
 Definition
Seronegative
Term
What percentage of health people have RF (roughly)?
 Definition
At least 5%
Term
Is the prognosis of those with RF and RA better or worse?
 Definition
Worse.
Term
What are the four main radiological signs of RA?
 Definition
Soft-tissue swelling.
Periarticular osteoporosis
Juxta-articular erosions
Narrowing of joint space.
Term
Where do radiological changes in RA tend to first appear?
 Definition
The small joints of the hands and feet.
Term
What are the two main aims of the drug treatment of RA?
 Definition
Reduction of symptoms
Prevention of damage via control of the disease.
Term
Do NSAIDs have any effect on the activity or progression of RA?
 Definition
No.
Term
In RA, what can NSAIDs improve?
 Definition
Joint pain and stiffness.
Term
What do DMARDs stand for?
 Definition
Disease Modifying Antirheumatic Drugs
Term
How soon should DMARD therapy be commenced after RA disease onset, at most?
 Definition
6 weeks.
Term
Are DMARDs fast or slow acting?
 Definition
Slow acting.
Term
If a patient does not respond adequately to 1 DMARD, what can you do?
 Definition
At to it or substitute it with a second DMARD.
Term
Give three rare but serious side effects of DMARDs.
 Definition
Bone marrow suppression
Abnormal liver function
Renal impairment.
Term
What tests should a person taking methotrexate have and how often?
 Definition
FBC and tests of liver and renal function, every 4-8 weeks.
Term
What can corticosteroids do in RA?
 Definition
Swiftly improve pain and swelling.
Term
Why might an injection of corticosteroids be given via IM or IV routes?
 Definition
To treat a generalised flare of RA.
Term
Why might an injection of corticosteroids be given intra-articularly?
 Definition
To treat local synovitis.
Term
When and why might low doses or oral prednisolone be given in RA?
 Definition
Early in the disease, to control symptoms before DMARDs become effective.
Term
Name a soluble TNF-alpha receptor
 Definition
Etanercept
Term
Name 4 monoclonal antibodies against TNF-alpha
 Definition
Infliximab, certolizumab, golimumab, adalimumab
Term
Give two reasons why the use of biological therapies is restricted.
 Definition
They are expensive and carry an increased risk of infection.
Term
What are Infliximab, certolizumab, golimumab, adalimumab all?
 Definition
Monoclonal antibodies against TNF-alpha.
Term
Name an anti-CD20 drug.
 Definition
Rituximab
Term
Name an anti-IL-1 drug
 Definition
Andakinra
Term
Name an anti-IL-6R drug.
 Definition
Tocilizumab.
Term
What is rituximab?
 Definition
A biological drug for RA, a monoclonal antibody against B cells.
Term
When is rituximab used in RA.
 Definition
When one anti-TNF therapy has failed.
Term
What is abatacept
 Definition
A biological drug for RA, a T-cell co-stimulation modulator.
Term
What is tocilizumab
 Definition
A biological drug for RA, a monoclonal antibody that blocks IL-6 to suppress the acute phase response of inflammation.
Term
What percentage of patients with RA are no longer at work after 3 years?
 Definition
25%
Term
Give 5 possible side effects of methotrexate.
 Definition
GI upset
Oral Ulcers
Raised Liver Enzymes
Pneumonitis
Bone Marrow suppression
Term
Give 5 possible side effects of Sulfasalazine.
 Definition
GI upset
Raised liver enzymes
Bone marrow suppression
Term
Give a side effect of hydroxychloroquine
 Definition
Retinal Damage
Term
Give three side effects of Leflunomide.
 Definition
Hypertension
GI upset
Bone marrow suppression
Term
Give three side effects of gold.
 Definition
Rash
Proteinuria
Bone marrow suppression.
Term
Name 5 DMARDs
 Definition
Methotrexate
Sulfasalozine
Hyroxychloroquine
Leflunomide
Gold.
Term
What 2 cells do Activated T-cells activate in RA?
 Definition
Macrophages and B-cells
Term
Give three cytokine produced by activated macrophages.
 Definition
TNF-alpha, IL-6, IL-1
Term
Give a cytokine produced by activated B cells
 Definition
IL-8
Term
What cells produce RF?
 Definition
Activated B cells.
Supporting users have an ad free experience!