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Simmons NURP 503 Exam 2 > 7: RA > Flashcards

7: RA Flashcards

1
Q

What decades have peak incidence of RA?

A

4th and 5th

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2
Q

Is RA more common in males or females?

A

2.5x more common in females

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3
Q

Which ethnicity has a high prevalence of RA?

A

Some Native American populations have a rate of 5%.

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4
Q

How long must symptoms be present before RA can be diagnosed?

A

6 weeks

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5
Q

Is RA symmetrical or asymmetrical?

A

Symmetrical

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6
Q

Is RA in one joint or multiple?

A

Multiple (considered polyarticular)

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7
Q

Is stiffness in RA more common when getting up in the morning or in the afternoon after using the joints?

A

Morning (of over an hour, but gets better with movement)

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8
Q

Is it common to have swelling in RA?

A

Yes, there is inflammatory synovitis (palpable synovial swelling).

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9
Q

Which joints are usually involved in RA (3)?

A
  1. Wrists
  2. MCP Joints
  3. PIP Joints
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10
Q

Which joints are usually spared in RA (3)?

A
  1. DIPs of the Fingers
  2. Thoracolumbar Spine
  3. IPs of the Toes
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11
Q

Key features of RA (6)?

A
  1. Symptoms 6+ weeks.
  2. Inflammatory synovitis (palpable synovial swelling).
  3. Morning stiffness.
  4. Symmetrical and polyarticular.
  5. Nodules at pressure points (esp where people lean on their arms).
  6. Serological markers (Rheumatoid factor, anti-CCP).
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12
Q

Is the rheumatoid factor positive in all cases of RA?

A

No, 50% positive in first 6 months. 85% positive as disease progresses over 2 years. Low titer not specific for RA, but high titer early is a bad sign.

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13
Q

T/F If both RF and anti-CCP are positive there is a lower correlation with erosive disease.

A

False. There is a higher correlation with erosive disease.

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14
Q

What will an x-ray show in RA?

A

Marginal erosions and joint space narrowing.

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15
Q

What is the classification criteria for RA (2)?

A
  1. Must have at least 1 joint with clinical synovitis not better explained by another disease.
  2. Score 6/10.
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16
Q

How many RA points do you score for:

1 large joint

A

0 (1 joint inconsequential)

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17
Q

How many RA points do you score for:

2-10 large joints

A

1

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18
Q

How many RA points do you score for:

1-3 small joints

A

2

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19
Q

How many RA points do you score for:

4-10 small joints

A

3

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20
Q

How many RA points do you score for:

Over 10 joints (at least 1 small joint)

A

5

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21
Q

How many RA points do you score for:

Negative RF and anti-CCP

A

0

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22
Q

How many RA points do you score for:

Low positive RF or anti-CCP

A

1

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23
Q

How many RA points do you score for:

High positive RF + anti-CCP

A

3

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24
Q

How many RA points do you score for:

Normal CRP and ESR

A

0

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25
Q

How many RA points do you score for:

Abnormal CRP or ESR

A

1

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26
Q

How many RA points do you score for:

Duration less than 6 weeks

A

0

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27
Q

How many RA points do you score for:

Duration more than 6 weeks

A

1

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28
Q

What is the pathogenesis of RA?

A

Synovial fluid is over-produced in RA. It can cause pain and inflammation. Panus (old, thickened synovial fluid) will eat away at the cartilage.

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29
Q

What causes RA morning stiffness?

A

Fluid in joints is thick like bad oil in a car. Stiffness can return during the day, especially after rest.

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30
Q

T/F Early erosion on x-ray leads to more advanced disease.

A

True

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31
Q

Name extra-articular manifestations that may happen with RA (6).

A
  1. Fatigue
  2. Raynaud’s Syndrome
  3. Dry Eyes/Mouth (secondary Sjogren’s syndrome)
  4. Interstitial Lung Disease
  5. Pleuritis or Pericarditis
  6. Vasculitis
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32
Q

T/F RA treatment is aggressive early on.

A

True. If damage occurs early, then start aggressive treatment early.

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33
Q

How frequently are RA patients monitored?

A

Monitor treatment for adverse effects at least every 2 months.

34
Q

What exercise is best for RA (3)?

A
  1. ROM
  2. Conditioning
  3. Strengthening
35
Q

Medication treatment for RA (types, not specifics) (2)?

A
  1. Analgesic/anti-inflammatory

2. Immunosuppressives (cytotoxin, biologic)

36
Q

T/F Significant radiographic damage may be seen in patients within the first 2 years after presentation of RA.

A

True. That’s why treatment may need to be aggressive.

37
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
Symptomatic relief, improved function.

38
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
No change in disease progression.

39
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
May substitute for NSAIDs.

A

Low-dose prednisone (<10 mg/day)

40
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
Use as bridge therapy

A

Low-dose prednisone (<10 mg/day)

41
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
If used long-term, consider prophylactic treatment for osteoporosis.

A

Low-dose prednisone (<10 mg/day)

42
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
Specific for 1-2 joints

A

Intra-articular steroids

43
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
Sulfasalazine

44
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
Hydroxychloroquine (Plaquenil)

45
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
Leflunomide

46
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
Methotrexate

A

Immunosuppressive (effective single DMARD)

47
Q

NSAIDs, low-dose prednisone, intra-articular steroids, DMARDs, immunosuppressive?
Azathioprine

A

Immunosuppressive

48
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Moderate effect. Low Cost.

A

Sulfasalazine

Hydroxychloroquine (Plaquenil)

49
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Toxicity similar to Methotrexate.

A

Leflunomide

50
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Combo with Methotrexate improves s/s in Methotrexate-failing RA.

A

Leflunomide

51
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Effective single DMARD.

A

Methotrexate

52
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Good benefit-to-risk ratio.

A

Methotrexate

53
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Slow onset. Reasonably effective.

A

Azathioprine

54
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Effective for vasculitis. Less so for arthritis.

A

Cyclophosphamide

55
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Superior to placebo. Renal toxicity.

A

Cyclosporine

56
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Gold standard in RA treatment.

A

Methotrexate

57
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Long-term data shows efficacy in relieving s/s of RA.

A

Methotrexate

58
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Limited data on inhibition of structural damage.

A

Methotrexate

59
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Main concerns are hepatotoxicity and bone marrow suppression.

A

Methotrexate

60
Q

Sulfasalazine, Hydroxychloroquine (Plaquenil), Leflunomide, Methotrexate, Azathioprine, Cyclophosphamide, or Cyclosporine?
Increased risk of lymphoma with long-term use.

A

Methotrexate

61
Q

T/F Any autoimmune disease increases risk of lymphoma, with or without meds.

62
Q

How often are checkups on Methotrexate?

A

At least every 8 weeks, but every 2-3 weeks at first. Concern for hepatotoxicity and bone marrow suppression.

63
Q

T/F Methotrexate shows prevention or reduction of bone erosion.

A

False. New medication studies show that, but Methotrexate wasn’t studied.

64
Q

Is this a TNF inhibitor, Costimulation modulator, B cell depletion, IL-1 inhibitor, IL-6 inhibitor, or Janus/Jak kinase inhibitor?
Remicade IV

A

TNF inhibitor

65
Q

Is this a TNF inhibitor, Costimulation modulator, B cell depletion, IL-1 inhibitor, IL-6 inhibitor, or Janus/Jak kinase inhibitor?
Embrel SC

A

TNF inhibitor

66
Q

Is this a TNF inhibitor, Costimulation modulator, B cell depletion, IL-1 inhibitor, IL-6 inhibitor, or Janus/Jak kinase inhibitor?
Humira SC

A

TNF inhibitor

67
Q 
Is this a TNF inhibitor, Costimulation modulator, B cell depletion, IL-1 inhibitor, IL-6 inhibitor, or Janus/Jak kinase inhibitor?
Cimzia SC (2x/month)
A

TNF inhibitor

68
Q 
Is this a TNF inhibitor, Costimulation modulator, B cell depletion, IL-1 inhibitor, IL-6 inhibitor, or Janus/Jak kinase inhibitor?
Simponi SC (1x/month)
A

TNF inhibitor

69
Q

Is this a TNF inhibitor, Costimulation modulator, B cell depletion, IL-1 inhibitor, IL-6 inhibitor, or Janus/Jak kinase inhibitor?
Orencia SC/IV

A

Costimulation modulator

70
Q

Is this a TNF inhibitor, Costimulation modulator, B cell depletion, IL-1 inhibitor, IL-6 inhibitor, or Janus/Jak kinase inhibitor?
Rituxan IV

A

B cell depletion

71
Q

Is this a TNF inhibitor, Costimulation modulator, B cell depletion, IL-1 inhibitor, IL-6 inhibitor, or Janus/Jak kinase inhibitor?
Anikinra SC

A

IL-1 inhibitor

72
Q

Is this a TNF inhibitor, Costimulation modulator, B cell depletion, IL-1 inhibitor, IL-6 inhibitor, or Janus/Jak kinase inhibitor?
Actemra SC/IV (q 4 weeks)

A

IL-6 inhibitor

73
Q

Is this a TNF inhibitor, Costimulation modulator, B cell depletion, IL-1 inhibitor, IL-6 inhibitor, or Janus/Jak kinase inhibitor?
Tofacitinib (Xeljanz) PO

A

Janus/Jak kinase inhibitor

74
Q

Due to the synovitis, there is bone erosion, pain, joint swelling, and joint space narrowing. Which ones are caused by osteoclasts, synoviocytes, and chondrocytes?

A

Bone Erosion = Ostoclasts
Pain = Synoviocytes
Joint Swelling = Synoviocytes
Joint Space Narrowing - Chondrocytes

75
Q

For patients with inadequate response to Methotrexate, _____ are effective in controlling RA symptoms.

A

TNF inhibitors

76
Q

T/F If patients fail Methotrexate, the next step are TNF inhibitors.

A

False. Try Methotrexate in combination with Plaquenil, Azathioprine, or Sulfasalazine first.

77
Q

If there is bone erosion, need to use _____.

A

TNF inhibitors

78
Q

With TNF inhibitors, _____, _____, and _____ are frequent sites of adverse effects. So frequent monitoring is needed.

A

Blood, liver, and kidneys

79
Q

How often are patients monitored with anti TNF drugs?

A

Interval lab testing from 4-8 weeks. 12 weeks if no adverse effects after 1 year.
Most need to be seen 3-6x/year.

80
Q

T/F Treatment in RA should be monitored and changed based on disease activity.

Simmons NURP 503 Exam 2 (17 decks)

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