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IBI Test 2 Leesy > B3.023 - Rheumatoid Arthritis > Flashcards

B3.023 - Rheumatoid Arthritis Flashcards

1
Q

What is non inflammatory arthritis

A

osteoarthritis, due to mechanical wear and tear

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2
Q

What is inflammatory arthritis

A

Immune system is the culprit, targeting the joints

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3
Q

What are the multiple types of inflammatory arthritis

A

Rheumatoid, psoriatic, chron’s disease related

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4
Q

What is the difference between primary and secondary osteoarthritis

A

Primary - due to mechanical derangement of joint

Secondary - due to trauma, genetic conditions

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5
Q

What are the most common places of osteoarthritis

A

Knee
Hip
Hands

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6
Q

What hand joints are the common points of osteoarthritis

A

PIPs
DIPs
Carpometacarpal (base of thumb)

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7
Q

What is the prevalence of RA

A

1%

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8
Q

What are the peak ages of onset of RA

A

50-75

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9
Q

RA spares what finger joints

A

DIPs

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10
Q

What are characteristics of presentation of RA

A

Symmetric polyarticular involvement

Upper and lower extremity involvement

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11
Q

Describe the onset of stiffness in RA patients

A

Morning stiffness usually >1 hour

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12
Q

Characterize morning stiffness in OA

A

<30 minutes

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13
Q

What do hands of RA patients look/feel like

A

Boggy, swollen and you cant see wrinkles

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14
Q

Describe the joint changes in RA patients hands

A

Ulnar deviation at MCPs
Swan neck
Boutonniere deformity
Cannot be straightened out in clinic

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15
Q

What are exam clues for osetoarthritis

A

Distribution of joints particularly in DIPs
Bony appearing changes
No ulnar deviation

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16
Q

What are extraarticular manifestations of RA

A 
pleural effusion and pleurisy
Pulmonary nodules
Interstitial lung disease 
Pericarditis and pericardial effusion
myocarditis
Accelerated coronary artery disease
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17
Q

What is rheumatoid vasculitis

A

inflammation of blood vessels leads to occlusion and ischemia

18
Q

what are extraarticular manifestations of RA in the eye

A

Secondary sjogrens/keratoconjunctivitis sicca
Episcleritis and scleritis
Corneal melt

19
Q

What are the hematologic extraarticular manifestations of RA

A

Feltys syndrome

20
Q

What is feltys syndrome

A

Splenomegaly, leukopenia, RA

21
Q

What are the neurologic extraarticular symptoms of RA

A

Carpal tunnel
Entrapment neuropathy
Spinal cord compression

22
Q

What is the strongest genetic link to RA

A

Shared epitope highly similar to AA sequence in alleles in HLA-DRB1 locus

23
Q

What environmental factors contribute to RA

A

Silica exposure (Caplans syndrome)
Smoking
Peridontal disease
Gut microbiome

24
Q

What is the relevance of Th17 in RA

A

Th17 cell is an important link with innate immune system, B cells serve as antigen presenting cells.

25
Q

What is characteristic of H&E of RA

A

Fibrovascular tissue protrudes from inflamed synovium into the articular cartilage

26
Q

How does joint destruction in RA happen

A

Osteoclasts ultimately result in erosions and join deformities

27
Q

What labs can you do to diagnose RA

A

RF
CCP
ANA

28
Q

What labs can you get to assist with disease activity

A

ESR, CRP

29
Q

What labs can help you with medication monitoring

A

CBC with differential
Creatinine
AST/ALT

30
Q

What is RF

A

Autoantibodies that recognize determinants of the Fc portion of IgG

31
Q

What is CCP

A

Anti cyclic citrullinated peptide

32
Q

seropositive v seronegative

A

Seropositive - RF or CCP positive

Seronegative - negative RF, CCP

33
Q

What is a positive RF and CCP without arthritis indicative of

A

May identify patients in early process of disease

34
Q

What can radiographs look for

A 
periarticular osteopenia
symmetric join space loss
Marginal erosions
soft tissue swelling 
no new bone formation
35
Q

Distinguish between RA and OA on physical exam

A

RA - swelling, warm, erythema

OA - Bony changes

36
Q

Distinguish between morning stiffness between RA and OA

A

RA - >1 hour

OA - <1 hour

37
Q

Does OA have systemic symptoms?

A

No

38
Q

Does RA have systemic symptoms?

A

It can

39
Q

Distinguish between labs for RA and OA diagnosis

A

RA - +CCP/RF, elevated inflammatory markers

OA - normal findings

40
Q

Describe findings on a radiograph for RA

A

Erosions, periostitis, joint-space narrowing

41
Q

Describe findings on a radiograph in OA

A

Joint space narrowing, osteophytes, subchondral sclerosis

IBI Test 2 Leesy (13 decks)

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