11 Principles in the Management of Patients with Rheumatic Disease Flashcards
This should be the cornerstone of care for children with rheumatic disease
Expertise
First step in the care for children with rheumatic disease
Accurate diagnosis
T/F Team care is required for every child with a rheumatic disease
F, expensive and NOT required but should be available when needed
T/F A child with a rheumatic disease should be encouraged to be as physically active as possible
T
T/F There are currently no specific evidence-based dietary recommendations for the treatment of rheumatic diseases
T
Evidence-based advice for supplementation in rheumatic disease should include
1) Calcium + vitamin D particularly for children on GC
2) Folic acid for children on MTX
3) Supplemental iron with or w/o vitamin C for children with anemia of chronic illness
T/F Children with rheumatic disease on chronic GC are at risk for atherosclerosis
T
T/F Children with chronic inflammatory diseases are at increased risk for dyslipidemia and CV disease
T
T/F Immunization may exacerbate or initiate rheumatic disease
F
Nonlive vaccines appear to be safe in children with rheumatic disease while using GC at a dose of
≤2mkday
Nonlive vaccines appear to be safe in children with rheumatic disease while using MTX at a dose of
≤25mkweek
T/F Nonlive vaccines appear to be safe in children on DMARDs and biologics
T
Immunogenicity of vaccines has been shown to be appropriate despite reduced responses when on MTX at a dose of
> 15mkweek
Immunogenicity of vaccines has been shown to be appropriate despite reduced responses when on GC at a dose of
> 2mkday
___ (3) have been shown to greatly reduce responses to vaccines
Rituximab
Cyclophosphamide
Azathioprine
T/F TNF inhibitors have been shown to reduce immunogenicity of vaccines
F
Live attenuated vaccines are recommended for children with rheumatic disease unless on
1) High-dose DMARDs
2) High-dose GC
3) Biological agents
T/F Children with severe, active rheumatic disease should defer immunization until the disease is at a more stable, less active, or inactive state
T
T/F Ideally, antibody level against VZV should be known before start of immunosuppressive therapy
T
Varicella vaccine is generally contraindicated among patients on what medication/s
GC at 2mkday pred or its equivalent to a total of 20mg/day of pred or its equivalent in children who weigh >10kg taken for longer than 14 days
This medication should NOT be used for at least 6 weeks after varicella vaccination
Salicylate
Recommended for children on immunuppressives who test negative for varicella antibody
Immunize with varicella vaccine 3 week before starting therapy
Recommended for children on immunoppressives exposed to varicella
Receive VZV Ig within 72h after exposure
Recommended for children on immunosuppressives who develop chickenpox
Give oral or parenteral Acyclovir, stop immunosuppresive temporarily BUT continue GC
Recommendation re: live vaccine for children on immunosuppressive therapy
Should not receive any live virus or bacterial vaccines; once immunosuppressives are stopped, live vaccines may be given after a minimum of 3 months
Risk for opportunistic infections and varicella among children on immunosuppressives appear most commonly with use of what biologic agent
Anti-TNF
Prior to initiation of anti-TNF therapy, patients should be screened for
Latent Tb and Hep B immunity
The effectiveness of live vaccines may decrease if administered ___ prior to IVIg administration
2 weeks
MMR and varicella vaccines should be administered ___ after IVIg
8 months
If MMR and varicella are administered 14 days prior to IVIg, it is recommended that ___
They should be repeated 8 months after IVIg
Transition to adult care is a process that should start when
When a child reaches adolescence
