According to NICE, what's more crucial than specific criteria for diagnosing rheumatoid arthritis?

Clinical diagnosis.

Outline the 2010 ACR criteria for rheumatoid arthritis.

Require at least one joint with clinical synovitis, not better explained by another disease. Score 6/10 for definite rheumatoid arthritis.

What does category A in the ACR criteria focus on, and how is it scored?

Joint involvement. Scored based on the number and size of affected joints.

What does category B in the ACR criteria deal with, and how is it scored?

Serology. Scored based on rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) levels.

How do acute-phase reactants contribute to the ACR criteria, and how are they scored?

Contribute to classification. Scoring depends on results of tests measuring these reactants.

What is the primary antibody in rheumatoid arthritis, and why is it important?

Rheumatoid factor (RF); crucial for suspected rheumatoid arthritis diagnosis.

How is RF detected, and what conditions are associated with a positive result?

Detected via Rose-Waaler or Latex tests; associated conditions include Felty's syndrome, Sjogren's, and more.

What's the significance of anti-cyclic citrullinated peptide antibody in rheumatoid arthritis diagnosis?

Detectable up to 10 years before, crucial for early diagnosis, similar sensitivity to RF (around 70%) but higher specificity (90-95%).

Why is testing for anti-CCP antibodies recommended for RF-negative patients with suspected rheumatoid arthritis?

Anti-CCP antibodies aid in early detection; recommended for those negative for rheumatoid factor.

Why does NICE recommend x-rays for patients with suspected rheumatoid arthritis?

To assess joint damage, particularly in the hands and feet.

What is the primary management approach for patients with evidence of joint inflammation in rheumatoid arthritis?

Start a combination of disease-modifying drugs (DMARD) promptly, along with analgesia, physiotherapy, and surgery.

What are the initial therapy options for DMARD monotherapy in rheumatoid arthritis, according to NICE?

Methotrexate is widely used, along with sulfasalazine, leflunomide, or hydroxychloroquine for mild or palindromic disease.

How does NICE recommend monitoring the response to rheumatoid arthritis treatment?

Use a combination of CRP and disease activity (e.g., DAS28) for assessment.

What is the current indication for TNF-inhibitors in rheumatoid arthritis treatment?

Inadequate response to at least two DMARDs, including methotrexate.

What are some risks associated with TNF-inhibitors like etanercept, infliximab, and adalimumab?

Risks include reactivation of tuberculosis, demyelination (etanercept), and various administration methods (subcutaneous or intravenous).

What is the mechanism of action of Rituximab in rheumatoid arthritis treatment?

It's an anti-CD20 monoclonal antibody that results in B-cell depletion.

How is Abatacept administered, and what is its mechanism of action?

Given as an infusion, it's a fusion protein that modulates a key signal for T lymphocyte activation, leading to decreased T-cell proliferation and cytokine production.

What are typical features of rheumatoid arthritis presentation?

Swollen, painful joints in hands and feet, morning stiffness, gradual worsening involving larger joints over months, and a positive 'squeeze test.'

What are late features of rheumatoid arthritis, unlikely to be present in a recently diagnosed patient?

Swan neck and boutonnière deformities.

Name some poor prognostic features in rheumatoid arthritis.

Rheumatoid factor positive, anti-CCP antibodies, poor functional status at presentation, early erosions on X-ray, extra-articular features, HLA DR4 positivity, and insidious onset.

What does research suggest regarding gender and prognosis in rheumatoid arthritis?

Female gender is associated with a poor prognosis, according to both the American College of Rheumatology and NICE guidelines.

What are some early x-ray findings indicative of rheumatoid arthritis?

1. Loss of joint space 2. Juxta-articular osteoporosis 3. Soft-tissue swelling 4. Periarticular erosions 5. Subluxation"