Arthritis Flashcards
1
Q
Rheumatoid arthritis is symmetrical. True/false?
A
True
2
Q
Women are how many more times likely to develop RA than men?
A
Three times
3
Q
UK prevalence of RA in % is?
A
1%
4
Q
Which haplotype is associated with RA?
A
HLA-DR4
5
Q
Name two triggers of RA
A
- Smoking
- Stress
6
Q
The main structure affected in RA is the…
A
Synovium
7
Q
C1/C2 vertebral joint is rich in synovium. True/false?
A
True
8
Q
C1/C2 are the only vertebra readily affected by RA. True/false?
A
True - other areas don’t have as much synovium
9
Q
Pure RA involves cartilage degeneration. True/false?
A
False - no cartilage
10
Q
Osteoarthritis involves synovium. True/false?
A
False - only cartilage is involved in pure OA
11
Q
Both B and T cells are involved in RA. True/false?
A
True
12
Q
RA always has autoantibodies present. True/false?
A
False - seronegative RA exists
13
Q
In RA, which cells are over stimulated to progressively resorb the bone?
A
Osteoclast
14
Q
Early RA is defined as that which has…
A
Two years of onset of RA symptoms
15
Q
What is the therapeutic window to begin RA medication and ensure good outcomes?
A
3 months
16
Q
Having negative antibody screen rules out RA. True/false?
A
False - seronegative RA
17
Q
The three most commonly affected joints in RA are….
A
PIP, MCP and MTPs
18
Q
Trigger finger is a type of
A
Tenosynovitis
19
Q
Palindromic rheumatism is continual/episodic
A
Episodic
20
Q
Rheumatoid Factor is which class of antibody?
A
IgM
21
Q
Rheumatoid Factor is present in which % of patients?
A
20-50%
22
Q
Rheumatoid Factor is how specific for RA?
A
70-80%
23
Q
Anti-Cyclic Citrullinated Peptide is how specific for RA?
A
90-99%
24
Q
Patients can be RF negative and anti-CCP positive. True/false?
A
True
25
The current classification system for RA is the...
2010 ACR/ EULAR classification
26
Which % of RA diagnosis is clinical and history (as opposed to investigation)?
90%
27
In RA, early morning stiffness typically lasts...
>30 minutes
28
In OA, early-morning stiffness typically lasts
<30 minutes
29
Inflammatory markers are always raised in RA. True/false?
False
30
Plain X-rays are a useful form of diagnosing early RA. True/false?
False - no signs
31
Treatment changes of RA can be monitored with which investigation?
USS
32
What's the gold-standard imaging standard for RA?
MRI
33
MRI can distinguish X from Y, making it useful in differential of R.A?
```
X = Synovitis
Y = Synovial effusion
```
34
A DAS28 of <2.6 is considered to be
Remission
35
A DAS28 of >5.1. indicates
Active disease
36
Upon diagnosis of RA, DMARDs should be immediately commenced. True/false?
False - initial step with aspirin/NSAIDs, then add steroids, then trial DMARD
37
Patients on DMARD should be measured how often?
6 weeks DAS score taken
38
If more than 5 joints are involved, intra-articular steroid injection is recommended. True/false?
False - 5 is limit
39
Which drug must be co-prescribed with methotrexate?
Folic acid
40
Parenteral methotrexate has a risk of pneumonitis. True/false?
True
41
Which criteria is needed to move up treatment in RA?
DAS28>5.1 on 2 occasions at least 4 weeks apart
42
What investigations are important before commencing anti-TNF drugs?
Screen for latent TB, hepB/C, HIV, VZV
43
Describe late-stage RA signs of the hand (3)
- Boutonniere
- Ulnar deviation
- Swan-necking
44
IPEX Syndrome is caused by a mutation in which gene? What does this gene do?
FOXP3
| Develops regulatory T-cells
45
HLA-B27 is associated with which disease?
Ankylosing spondylitis
46
RA is which type of hypersensitivity?
Type 4
47
SLE is which type of hypersensitivity disease?
Type 3
48
All _____ cells express MHC class I on their membrane.
Nucleated
49
ANA is useful in making RA diagnosis. True/false?
False
50
Which cartilage type covers the surface of bone in synovial joints?
Hyaline
51
Proteoglycans in hyaline cartilage are hydrophilic/phobic?
Philic
52
Joint healing is done with which type of cartilage? Why is this "worse"?
Replacement is fibrocartilage, which has a greater friction and is less wear resistant
53
The underlying pathology in osteochondritis dessicans is...
Loss of blood supply. Bone +/- cartilage can shear off.
54
Cartilage regeneration can be done in all cases of OA. True/false?
False - only applicable in osteochondritis dessicans
55
Cartilage regeneration surgery is possible in the patello-femoral joint. True/false?
False
56
Partial knee replacement has higher or lower fail rate than TKR?
Higher
57
What's the average expectancy of a TKR?
15-20 years
58
What's the risk of deep infection in TKR replacement?
1%
59
Paracetamol is a pure analgesic with very little anti-inflammatory property. True/false?
True
60
Example NSAIDs used in arthritis (3)
- Ibuprofen
- Naproxen
- Diclofenac
61
Side-effects of NSAIDs (3)
- Peptic ulceration
- Dyspepsia
- Oesophagitis
62
COX-2 is commonly targeted by which class of drug?
NSAID
63
DMARDs have analgesic properties. True/false?
False - pure anti-inflammatories
64
DMARDs should be started how soon after a RA diagnosis?
Within 3 months
65
Step 1 treatment option for RA is (2)
Non-opioid analgesic (such as aspirin, paracetamol or NSAID) +/- adjuvant
66
Step 2 treatment option for pain in RA Is
Weak opioid for mild to moderate pain (e.g. codeine) +/- non-opioid
67
Step 3 treatment option for RA pain is...
Strong opioid for moderate to severe pain (e.g. morphine) +/- non-opioid
68
Which DMARDs have the "least" toxicity profile?
1) Methotrexate
| 2) Sulfasalazine
69
What's the MoA of methotrexate?
Unknown - only known it is a folate antagonist
70
Side effects of methotrexate include (3)
1) Lecopenia
2) Hepatitis
3) Later, cirrhosis
71
How long should methotrexate be stopped prior to conception? Why?
At least 3 months - it is highly teratogenic
72
Side-effects of sulfasalazine include (4)
1) Nausea
2) Rash/mouth ulcers (potentially Stevens-Johnson Syndrome)
3) Neutropenia
4) Oligospermia
73
Hydroxychloroquine has what effect on joint damage?
None
74
Hydroxychloroquine is used in which type of disease?
Connective tissue diseases (such as SLE, Sjorgen's, RA)
75
Sodium aurothiomate is a type of what?
DMARD - not used any more due to BM suppression and kidney damage
76
Penicillinamine as a DMARD has which side-effects?
Same as gold - kidney damage,BM suppression
77
Which DMARDs require regular FBCs & LFTs?
Methotrexate and sulfasalazine
78
Biologic therapies are delivered via which route?
S/C
79
What are side-effects of biologics?
- Malignancy (especially skin cancer)
- Risk of infection (especially TB)
- Contraindicated in pulmonary fibrosis
80
Tocilizumab targets what?
IL-6
81
Abatacept targets what?
CTLA-4 (blocking T-cell activation)
82
Ustekinumab targets what?
IL-12 and IL-23 (involved in psoriatic arthritis)
83
What's more common, sternoclavicular joint arthritis or AC joint arthritis?
AC joint
84
Symptoms of glenohumeral OA include (3)
1) Pain
2) Crepitus
3) Loss of ROM
85
Reverse geometry shoulder replacement is an alternative surgery which involves which muscle? What condition is it used for?
Deltoid & treatment of rotator cuff tear
86
OA is commonly polyarticular. True/false?
False - RA tends to be polyarticular
87
RA tends to involve the joint spaces narrowing early on. True/false?
False - OA has early narrowing
88
Which hand joints are commonly implicated in OA?
DIP + PIP
89
MCP joints are involved in OA/RA?
RA
90
What are the hand signs of OA?
1) Heberdens (DIP) nodes
| 2) Bouchard nodes (PIP)
91
Psoriatic arthritis can result in which sign on x-ray?
Pencil-in-cup
92
What % of rheumatoid arthritis presents as a monoarthritis?
30%
93
What common presentations are associated with RA?
Trigger finger, tenosynovitis, carpal tunnel, palindromic rheumatism
94
What is more specific, Rheumatoid Factor or anti-CCP?
Anti-CCP
95
Anti-CCP is only positive at symptom onset in RA, T/F?
False - it can be positive for years before symptoms
96
Anti-CCP is associated with smoking, T/F?
True
97
Anti-CCP will be high/low with disease severity, true or false?
True
98
Anti-CCP is a useful marker in judging treatment of RA. T/F?
False - will always be positive
99
Steroids can be used as a monotherapy in RA, T/F?
False - only as a bridge between flares
100
How many DMARDs can be given at once?
3 (plus steroids plus aspirin/NSAIDs)
101
List 2 anti-TNFalpha antibodies?
Infliximab, adaluminab
102
List 1 anti-TCR antibody
Abatacept
103
List 1 anti-Bcell antibody
Rituximab
104
Biologics are ONLY used if which criteria are met?
If patient fails to respond to 2 DMARDs (one of which is MTX) AND has a Das28 of >5.1 on at least 2 occasions 4 weeks apart.
105
T/F: Live vaccines can be given in biologic therapy?
False
106
C1-C2 subluxation is a complication of RA, T/F?
True - C1 and C2 are rich in synovium.
107
A young woman with rheumatoid arthritis mentions she is thinking of starting a family. Her current medication is MTX 15mg/weekly. What should she do about her medication/
Come off it and wait 3 months before trying to conceive. Replace with steroids + possibly another DMARD (?)
RA will improve in pregnancy
108
A 36 year old man has very sore joints despite treatment with MTX, SZS and hydroxychloroquine. His DAS28 is 5,88. He is commenced on a new therapy but later returns with cough, 2 stone weight loss, night sweats and fever. What has likely occured?
He likely has an underlying infection (e.g. TB) which has been reactivated by his anti-TNFalpha therapy.
109
A 42 year old female is commenced on aspirin, steroids and methotrexate for his rheumatoid arthritis. He has crackles at both lung bases. Which medication is likely responsible & condition?
Methotrexate - methorexate pneumonitis
110
Which NSAID is COX-2 selective? Why is using this advantageous?
Celecoxib.
| It has a lower chance of giving peptic ulcer.
111
GI Side effects of NSAIDs
Dyspepsia, oesophagitis, gastritis, peptic ulcer, small/large bowel ulcer
112
Is renal impairment a side-effect of NSAID use?
Yes
113
Which lab results will DMARDs improve in patients with RA?
ESR, CRP
114
What are the side-effects of methotrexate? (5)
1) Leucopaenia/ thrombocytopenia
2) Hepatitis
3) Pneumonitis
4) Rash/ mouth ulcers (SJS)
5) Teratogenic
115
What are the side-effects of leflunomide?
Similar to MTX (low WBCs and PLTs, hepatitis, pneumonitis, teratogenic)
116
What are the side-effects of sulfasalazine? (4)
1) Rash/mouth ulcers (SJS)
2) Neutropenia
3) Reversible oligozoospermia
4) Hepatitis
117
What is the main side-effect of hydroxychloroquine?
Retinopathy
118
How much more effective is anti-TNF therapy than conventional DMARDs?
1.5x
119
How are anti-TNFs administered?
S/C
120
List some anti-TNF drugs (3)
1) Etanrecept
2) Adaluminab
3) Infliximab
121
What are the side-effects of anti-TNF drugs? 2
1) Risk of TB infection
2) Possible cancer (esp skin)
Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure
122
Secukinab inhibits what?
IL-17
123
Tocilizumab inhibits what?
IL-6 (used in RA)
124
Abatacept inhibits what? What is it used in?
Activation of T-cells
| Used in psoriatic arthritis
125
Is rituximab used in spondyloarthropathy?
No (only in RA and CTD)
126
RA hand signs
Boutinnere's deformity, ulnar deviation, swan neck
