Share your insights

Help us by sharing what content you've recieved in your exams


Rheumatoid arthritis

Background knowledge ๐Ÿง 

Definition

  • Chronic, systemic autoimmune disease
  • Characterized by symmetrical polyarthritis, predominantly affecting small joints
  • Associated with extra-articular manifestations
  • Progressive joint destruction and deformity if untreated

Epidemiology

  • Prevalence in the UK: ~1% of the population
  • Female to male ratio: 3:1
  • Peak onset: 40-60 years
  • Higher prevalence in smokers and those with a family history of RA

Aetiology and Pathophysiology

  • Genetic factors: HLA-DR4 and HLA-DR1 associated
  • Environmental triggers: Smoking, infections
  • Immune response: Autoantibody production (RF, anti-CCP)
  • Inflammation: Synovial membrane inflammation leading to pannus formation and joint damage

Types

  • Seropositive RA: Presence of RF and/or anti-CCP antibodies
  • Seronegative RA: Absence of these antibodies
  • Juvenile idiopathic arthritis: RA variant in children under 16 years

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Joint pain: Typically symmetrical, affecting small joints of hands and feet
  • Morning stiffness: Lasting more than 30 minutes
  • Fatigue: Common systemic symptom
  • Other symptoms: Weight loss, low-grade fever, malaise

Signs

  • Swollen, tender joints: Particularly MCP, PIP, and MTP joints
  • Deformities: Ulnar deviation, swan neck, boutonniere deformities
  • Rheumatoid nodules: Subcutaneous nodules, often over pressure points
  • Extra-articular features: Eye involvement (scleritis), lung fibrosis, pericarditis

Investigations ๐Ÿงช

Tests

  • Blood tests: RF (positive in ~70%), anti-CCP (more specific), ESR and CRP (elevated in active disease)
  • Imaging: X-rays (joint space narrowing, erosions), ultrasound or MRI (synovitis, early erosions)
  • Other tests: FBC (anemia of chronic disease), renal and liver function tests (before starting DMARDs)

Management ๐Ÿฅผ

Management

  • DMARDs: Methotrexate (first-line), sulfasalazine, leflunomide
  • Biologics: Anti-TNF agents (e.g., etanercept, adalimumab) for severe disease
  • Steroids: Oral or intra-articular for flare-ups
  • NSAIDs: For symptom relief
  • Non-pharmacological: Physiotherapy, occupational therapy, patient education

Complications

  • Joint destruction and deformity
  • Cardiovascular disease: Increased risk of MI and stroke
  • Infections: Increased risk due to immunosuppressive therapy
  • Osteoporosis: Due to chronic inflammation and steroid use
  • Amyloidosis: Rare but serious complication

Prognosis

  • Variable: Some patients achieve remission, others have progressive disease
  • Early and aggressive treatment improves outcomes
  • Increased mortality: Mainly due to cardiovascular disease

Key Points

  • RA is a chronic, systemic autoimmune disease with a significant impact on quality of life
  • Early diagnosis and treatment are crucial for preventing joint damage and complications
  • Management involves a combination of pharmacological and non-pharmacological approaches
  • Regular monitoring for disease activity and treatment side effects is essential
  • Patient education and support are vital for managing this long-term condition

No comments yet ๐Ÿ˜‰

Leave a Reply