Arthritis 1 Flashcards
In summary how is RA treated? (3 main points)
- if patient has active disease start on short course of NSAID or corticosteroid to quell inflammation
- simultaneously start long-term DMARD (methotrexate first line)
- if MTX alone doesn’t help add other DMARDs (hydroxychloroquine)
T/F: RA often improves or remits during pregnancy.
True
This is defined as the boundary between articular and periarticular structures of a joint.
joint capsule
When you see a red swollen knee with no other information you should consider this diagnosis until proven otherwise.
septic arthritis
What is the MOA of methotrexate?
- inhibits dihydrofolate reductase
- which decreases thymine
- thymine is required for DNA synthesis
What are the 6 causes of cavitary lesions in the lung?
- Cancer
- Autoimmune
- Vascular
- Infection
- Trauma
- Youth
What are the 2 DMARDs that are safest to use during pregnancy?
- Hydroxychloroquine
- Sulfasalazine
AVOID MTX and leflunomide
What type of anemia is an adverse effect of methotrexate?
megaloblastic anemia (check MCV)
Which of the following is considered a Disease Modifying Anti-Rheumatic Drug (DMARD)?
a. NSAIDs
b. Corticosteroids
c. Methotrexate
d. Colchicine
e. Allopurinol
c. Methotrexate
What are the 4 nonbiologics that are considered Disease Modifying Anti-Rheumatic Drugs (DMARD)?
- methotrexate
- sulfasalazine
- hydroxychloroquine
- leflunomide
In rheumatoid arthritis the joint destruction is due to ______ .
synovitis
What is the most common subtype of juvenile idiopathic arthritis?
a. oligoarticular JIA
b. polyarticular JIA
c. systemic JIA
a. oligoarticular JIA
If you are starting DMARDs patients should be medical screened for what conditions?
- pregnancy with HCG
- renal and liver disease with CMP
- Hep C
- tuberculosis
What are the 3 reasons an anti-CCP test may be a better measure of RA than a rheumatoid factor (RF)?
- more specific (>90%)
- may develop in patients before RF
- may predict more aggressive disease course
Based on the WBC/mm3, how can you distinguish between a normal, non-inflammatory, inflammatory, and septic knee with an arthrocentesis?
- normal = <500 white
- non-inflammatory = <500 yellow
- inflammatory = >5,000
- septic = >50,000
A 36-year-old male is referred to your clinic complaining of fever, rash, and joint pains for two weeks. He endorses daily fevers up to 103. The rash is ‘salmon’ colored, non-pruritic, non-painful, occurs on his trunk, and seems to appear with fevers, then resolve after. He has associated joint pains, sore throat, and fatigue. What is the most likely diagnosis?
Still’s disease (aka systemic JIA)
salmon colored rash that appears with quotidian fever
A patient with RA preparing to undergo a lengthy surgery under general anesthesia should have which of the following tests prior to surgery?
a. plain films of hands
b. plain films of c-spine
c. chest x-ray
d. CBC with diff
e. Rheumatoid factor
b. plain films of c-spine
* need to assess for subluxation of C1-C2*
An ulnar drift is classic for what type of arthritis?
rheumatoid arthritis
The hallmark of this disease are flares of morning stiffness, pain, and swelling, that is IMPROVED with use.
a. osteoarthritis
b. rheumatoid arthritis
b. rheumatoid arthritis
* opposite of osteoarthritis which gets WORSE with use*
When diagnosing RA why do you want to get a rheumatoid factor (RF) and an anti-CCP test?
- rheumatoid factor is not specific for RA (seen in other diseases)
- anti-CCP more specific!
What are the 3 main side effects with hydroxychloroquine?
- macular toxicity with long-term use
- prolongs QT
- rashes
What is the feared complication of Systemic JIA (aka Still’s disease)?
macrophage activation syndrome
To diagnose rheumatoid arthritis these 5 criteria must be met.
- inflammatory arthritis of 3+ joints
- positive rheumatoid factor and/or anti-CCP test
- elevated ESR and CRP
- diseases with similar clinical features have been excluded
- duration of symptoms >6 weeks
When measuring the rheumatoid factor (RF) for RA the _____ the titer the greater the probability of destructive disease.
greater
Hydroxychloroquine was originally developed for treatment of?
Malaria
In rheumatoid arthritis the hands are almost always involved, especially the _____ and ______ joints.
- MCP and PIP
* DIP rarely involved because it has the smallest joint capsule*
What ethnicity has the highest risk of rheumatoid arthritis?
native americans
What are the 4 diagnostic criteria for juvenile idiopathic arthritis (JIA)?
- arthritis
- age of onset <16
- duration of disease >6 weeks
- exclusion of other causes
REFER TO PEDIATRIC RHEUMATOLOGIST
This is defined as the area of attachment of a tendon or ligament and the bone.
enthesis
Every patient that is on methotrexate needs to take this supplement.
folate
