3.4.1 Treatment of Arthritis

Question 1

What type of pharmalogics are possible for OA?

Answer 1

Acetaminophen: under 3 mg

NSAIDS

COX-2 Inhibitors

Glucosamine, Chondroitin, Opiates

Capsaicin (modest benefit)

Intraarticular (IA) injections

Question 2

What characteristics are checking in each joint?

Answer 2

Warmth?

Swelling?

Tenderness?

Limitation of motion?

Question 3

What are some of the biologic disease-modifying options for rheumatoid arthritis?

Answer 3

Question 4

What are some of the nonpharmacologic approaches to treating RA?

Answer 4

physical therapy, occupational therapy, reconstructive surgery

Question 5

How long must patients be off rheumatoid medications prior to surgery and after?

Answer 5

Off medication 6 wks prior

Off medication 4 wks after

Question 6

What are two markers for rheumatoid arthritis?

Answer 6

Rheumatoid factor and anti-CCP Ab (patients can be seronegative then progress to seropositive, these can also act as prognostic markers)

Question 7

Worse with activity, frequently in hands in knees. What type of joint pain?

Answer 7

Non-inflammatory joint pain

Question 8

What type of nodes are labeled 1? 2?

Answer 8

1 = herberden’s nodes

2 = bouchard’s nodes

Question 9

What are the two lab values that act as inflammatory markers?

Answer 9

C reactive protein and creatinine

Question 11

What are some non-biologic disease-modifying drugs for arthritis?

Answer 11

Question 12

What is the most common crystal-induced form of arthritis?

Answer 12

Gout (urate crystals)

Question 13

These are features of what imaging modality?

Answer 13

MSK ultrasound

Question 14

What are some of the nonpharmacologic treatments for OA?

Answer 14

Exercise, unloading, realignment, and acupuncture

Question 15

Which joints are involved in this RA patient?

Answer 15

PIPs of LIF and LMF

Question 16

What is one of the more important criteria for RA?

Answer 16

Number of joints involved

Question 17

What are some common characteristics of joints affected by RA?

Answer 17

Swelling!

Not as common - tenderness, warmth, and limitation of movement (LOM)

Question 18

What are some imaging techniques that can be used to catch changes in joints prior to changes being seen on x-ray? (more sensitive)

Answer 18

ultrasound

MRI (w/ or w/out) gadolinium contrast

Question 19

These are features of what imaging modality?

Answer 19

MRI

Question 20

What are some of the systemic symptoms of RA?

Answer 20

fatigue and malaise

Question 21

How hard do you press when checking a joint?

Answer 21

Maximum - Until blanching of your distal nail

Question 22

What is the genetic marker of ankylosing spondylitis?

Answer 22

HLA-B27

Question 23

When is joint stiffness most commonly noted in RA patients?

Answer 23

Morning stiffness

Question 24

What is the difference b/t primary and secondary failures in regards to remicade treatment?

Answer 24

Primary: never respond to the drug

Secondary: Respond to drug, then have to get off drug for some reason. The drug isn’t efficacious once they start taking drug again.

Question 25

What is the genetic factor that predisposes for rheumatoid arthritis?

Answer 25

HLA-DR4