RA

Question 1

what is rheumatology

Answer 1

the study of arthritis and other related conditions

Question 2

what is arthritis

Answer 2

inflammation of a joint

Question 3

what are some of the symptoms of arthritis

Answer 3

• pain
• swelling
• functional impairment
• stiffness
• redness over joint

Question 4

what are the clinical signs of arthritis

Answer 4

• limited range of movement
• redness/heat over joint
• swelling
• tenderness

Question 5

name some different types of arthritis

Answer 5

• osteoarthritis
• RA
• crystal arthritis
• seronegative arthritis

Question 6

what is the normal function of the synovium

Answer 6

1) lubrication of the cartilage
2) nutrition of the cartilage
3) maintenance of the tissue surface

Question 7

what is the synovium

Answer 7

a membrane that surrounds the inner surface of the cartilage of synovial joints

Question 8

what happens if a joint is affected with RA

Answer 8

there is inflammation of the synovial and the tendon sheath - as the disease progresses there is destruction of the cartilage and the bone and this makes movement painful

Question 9

what are the most common joints addicted in RA

Answer 9

the small joints of the hands and feet

Question 10

what cells are found in the synovial during flare ups of RA

Answer 10

neutrophils

Question 11

name some antibodies that are associated with RA

Answer 11

RF and anticitruinated antibodies (anti CCP and ACPA)

Question 12

what is the difference between seropositive and sero-negative arthritis

Answer 12

sero+ means there are antibodies detectable in the patients serum and sero- means that there are no antibodies detectable in the patients serum

Question 13

name some environmental factors that are associated with RA

Answer 13

• smoking
• bronchial stress/exposure to silica
• periodontal disease
• E. coli infection
• viruses (EBV and CMV)

Question 14

what is citrullination

Answer 14

this is the conversion of the amino acid arginine into the amino acid citulline - in RA some antibodies are directed against the citrullinated proteins and these antibody markers are used in the diagnosis of RA

Question 15

what happens in synovitis

Answer 15

synovitis = inflammation of the synovial membrane

there is villous hyperplasia, infiltration of B cells and T cells, fibroblast proliferation and increased vascularity

Question 16

what mediates the bone and cartilage destruction in RA

Answer 16

the osteoclasts

Question 17

what is RA

Answer 17

a chronic and symmetrical autoimmune disease that is characterised by peripheral arthritis

Question 18

what are specific signs that lead to the diagnosis of RA

Answer 18

• morning stiffness that lasts at least 1 hour before maximum movement can be reached
• small joints in the hands and feet
• symmetrically arthritis
• rheumatoid nodules
• at least 3 joints affected at the same time
• serum antibody markers
• radiographic changes - erosion or decalcification of the affected joints

Question 19

who is most commonly affected by RA

Answer 19

women usually between 40-50 years old

Question 20

what are the symptoms of RA

Answer 20

pain, stiffness, swelling, poor mobility of the joint, systemic symptoms (fatigue, weight loss, anaemia)

Question 21

what is the DAS

Answer 21

this is the disease activity score used in RA - a score of less than 2.4 indicates clinical remission and a score of >5.1 is the cut off for eligibility for biologic treatment

Question 22

How is life expectancy affected in RA

Answer 22

reduced by 7 years on average

Question 23

name some therapeutics that are used in RA

Answer 23

• NSAIDs
• DMARD (disease modifying anti rheumatic drugs)
• biologics
• corticosteroids

Question 24

what is the DMARD of choice

Answer 24

methotrexate