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Rheumatology > Arthritis 1 > Flashcards

Arthritis 1 Flashcards

1
Q

In summary how is RA treated? (3 main points)

A
  • 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)
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2
Q

T/F: RA often improves or remits during pregnancy.

A

True

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3
Q

This is defined as the boundary between articular and periarticular structures of a joint.

A

joint capsule

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4
Q

When you see a red swollen knee with no other information you should consider this diagnosis until proven otherwise.

A

septic arthritis

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5
Q

What is the MOA of methotrexate?

A
  • inhibits dihydrofolate reductase
  • which decreases thymine
  • thymine is required for DNA synthesis
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6
Q

What are the 6 causes of cavitary lesions in the lung?

A
  • Cancer
  • Autoimmune
  • Vascular
  • Infection
  • Trauma
  • Youth
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7
Q

What are the 2 DMARDs that are safest to use during pregnancy?

A
  • Hydroxychloroquine
  • Sulfasalazine

AVOID MTX and leflunomide

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8
Q

What type of anemia is an adverse effect of methotrexate?

A

megaloblastic anemia (check MCV)

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9
Q

Which of the following is considered a Disease Modifying Anti-Rheumatic Drug (DMARD)?

a. NSAIDs
b. Corticosteroids
c. Methotrexate
d. Colchicine
e. Allopurinol

A

c. Methotrexate

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10
Q

What are the 4 nonbiologics that are considered Disease Modifying Anti-Rheumatic Drugs (DMARD)?

A
  • methotrexate
  • sulfasalazine
  • hydroxychloroquine
  • leflunomide
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11
Q

In rheumatoid arthritis the joint destruction is due to ______ .

A

synovitis

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12
Q

What is the most common subtype of juvenile idiopathic arthritis?

a. oligoarticular JIA
b. polyarticular JIA
c. systemic JIA

A

a. oligoarticular JIA

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13
Q

If you are starting DMARDs patients should be medical screened for what conditions?

A
  • pregnancy with HCG
  • renal and liver disease with CMP
  • Hep C
  • tuberculosis
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14
Q

What are the 3 reasons an anti-CCP test may be a better measure of RA than a rheumatoid factor (RF)?

A
  • more specific (>90%)
  • may develop in patients before RF
  • may predict more aggressive disease course
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15
Q

Based on the WBC/mm3, how can you distinguish between a normal, non-inflammatory, inflammatory, and septic knee with an arthrocentesis?

A
  • normal = <500 white
  • non-inflammatory = <500 yellow
  • inflammatory = >5,000
  • septic = >50,000
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16
Q

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?

A

Still’s disease (aka systemic JIA)

salmon colored rash that appears with quotidian fever

17
Q

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

A

b. plain films of c-spine

* need to assess for subluxation of C1-C2*

18
Q

An ulnar drift is classic for what type of arthritis?

A

rheumatoid arthritis

19
Q

The hallmark of this disease are flares of morning stiffness, pain, and swelling, that is IMPROVED with use.

a. osteoarthritis
b. rheumatoid arthritis

A

b. rheumatoid arthritis

* opposite of osteoarthritis which gets WORSE with use*

20
Q

When diagnosing RA why do you want to get a rheumatoid factor (RF) and an anti-CCP test?

A
  • rheumatoid factor is not specific for RA (seen in other diseases)
  • anti-CCP more specific!
21
Q

What are the 3 main side effects with hydroxychloroquine?

A
  • macular toxicity with long-term use
  • prolongs QT
  • rashes
22
Q

What is the feared complication of Systemic JIA (aka Still’s disease)?

A

macrophage activation syndrome

23
Q

To diagnose rheumatoid arthritis these 5 criteria must be met.

A
  • 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
24
Q

When measuring the rheumatoid factor (RF) for RA the _____ the titer the greater the probability of destructive disease.

A

greater

25
Q

Hydroxychloroquine was originally developed for treatment of?

A

Malaria

26
Q

In rheumatoid arthritis the hands are almost always involved, especially the _____ and ______ joints.

A
  • MCP and PIP

* DIP rarely involved because it has the smallest joint capsule*

27
Q

What ethnicity has the highest risk of rheumatoid arthritis?

A

native americans

28
Q

What are the 4 diagnostic criteria for juvenile idiopathic arthritis (JIA)?

A
  • arthritis
  • age of onset <16
  • duration of disease >6 weeks
  • exclusion of other causes

REFER TO PEDIATRIC RHEUMATOLOGIST

29
Q

This is defined as the area of attachment of a tendon or ligament and the bone.

A

enthesis

30
Q

Every patient that is on methotrexate needs to take this supplement.

A

folate

Rheumatology (7 decks)

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