Cheatography
https://cheatography.com
Information about RA, including presentation, management, investigations and diagnosis
General Information
Autoimmune condition causing synovitis of joints, tendon sheaths, and bursae |
Symmetrical and affects multiple joints |
3x more common in women |
Associated with HLA DR4 and HLA DR1 |
70% of RA patients have +ve RF |
Some patients will be anti-CCP +ve |
Hand Signs
Boggy feeling in synovium
Z-shaped deformity to thumb
Swan neck deformity (hyperextended PIP, flexed DIP)
Boutonnieres deformity (hyperextended DIP, flexed PIP)
Ulnar deviation of MCP joints
Diagnostic Criteria
More than 4/7 = diagnosis: |
Morning stiffness for >1hr for 6+ weeks |
3+ joints affected for 6+ weeks |
1+ joints in hand/wrist for 6+ weeks |
Symmetrical involvement of 1+ joints |
Presence of rheumatoid nodules |
High serum RF |
Consistent radiographic changes of hand or wrist |
Worse Prognosis
Younger onset |
Male |
More joints + organs |
RF + anti-CCP |
Erosions on XR |
|
|
Presentation
Key symptoms |
Symmetrical distal polyarthropathy |
| |
Pain, swelling, stiffness |
| |
Improves with activity |
| |
Morning stiffness >1hr |
Systemic symptoms |
Fatigue |
| |
Weight loss |
| |
Flu |
| |
Myalgia |
Extra-Articular Manifestations
Caplan's syndrome - pulmonary fibrosis, pulmonary nodules |
Bronchiolitis obliterans |
Felty's syndrome - RA, neutropenia, splenomegaly |
Secondary Sjogren's syndrome - sicca syndrome |
Anaemia of chronic disease |
CVD |
Episcleritis and scleritis |
Rheumatoid nodules |
Lymphadenopathy |
Carpel tunnel syndrome |
Amyloidosis |
Important Side Effects
Methotrexate |
Pulmonary fibrosis |
Leflunomide |
HTN
Peripheral neuropathy |
Sulfasalazine |
Male infertility (reduced sperm count)
Orange fluids |
Hydroxychloroquine |
Nightmares
Reduced visual acuity |
Anti-TNF medication |
Reactivation of TB or Hep B |
Rituximab |
Night sweats
Thrombocytopenia |
|
|
Joint Involvement
PIP joints |
MCP joints |
Wrist + ankle |
Cervical spine |
Can involve large joints (knees, hips, shoulders) |
Does not involve DIP joints |
Palindromic Rheumatism
Self-limiting, short episodes of inflammatory arthritis |
Presents with joint pain, stiffness and swelling |
Episode lasts 1-2 days then completely resolves |
A +ve RF and anti-CCP can indicate it will progress to RA |
Investigations
RF |
If -ve, check anti-CCP |
CRP + ESR |
XR of hands and feet |
USS to confirm synovitis |
XR Changes
Joint destruction and deformity |
Soft tissue swelling |
Periarticular osteopenia |
Bony erosions |
Management
MDT |
Steroids |
Short course initially + flare ups |
NSAIDs (+PPI) |
DMARDs |
1. Monotherapy with methotrexate/leflunomide/sulfasalazine
Hydroxychloroquine if mild
Take folic acid 5mg if on methotrexate |
| |
2. Dual therapy with above |
| |
3. Methotrexate + biological therapy (usually TNF inhibitor) |
| |
4. Methotrexate + rituximab |
| |
If pregnant - sulfasalazine or hydroxychloroquine |
Surgery |
|
Created By
Metadata
Comments
No comments yet. Add yours below!
Add a Comment
Related Cheat Sheets
More Cheat Sheets by ellieacook