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MM Test 2 > B6.037 Oligoarthritis > Flashcards

B6.037 Oligoarthritis Flashcards

1
Q

definition of oligoarthritis

A 
1-4 joints
not just arthritis; inflammation/synovitis is present
>6 weeks duration
almost always asymmetric
lower extremity predominant
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2
Q

what is JIA

A

juvenile idiopathic arthritis

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3
Q

age of JIA patients

A

<6

especially 1-4 years

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4
Q

race of JIA patients

A

typically white

northern European

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5
Q

different courses of JIA after 6 months

A

first 6 months: 1-4 joints
persistent (50%) = stays 4 or less
extended (50%) = >4 joints after 6 months

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6
Q

sex of JIA patients

A

3:1 girls: boys

in Asia, more boys

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7
Q

negative blood tests in JIA

A

RF

IgG anti-CCP (ACPA)

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8
Q

blood tests that has 8% chance of being positive in JIA

A

HLA-B27

prevalence in the general white population

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9
Q

autoantibody positive in 75-85% of JIA patients

A

ANA

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10
Q

common joints affected by JIA

A

knee > ankle > others

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11
Q

what might be an associated skin complication of JIA?

A

psoriasis

esp if the patient has wrist involvement

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12
Q

what is the uveal tract

A

pigmented part of the eye

choroid, ciliary body, and iris

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13
Q

symptoms of acute anterior uveitis

A

pain
photophobia
blurred vision
redness

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14
Q

in which JIA patients would you expect ocular inflammation

A

ANA+
oligoarticular-onset
25% get inflammatory eye disease, but few present with symptoms

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15
Q

what monitoring is done for patients with ANA+, oligoarticular onset, LE predominant arthritis

A

slit lap screening

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16
Q

do ANA- JIA patients have ocular involvement

A

no often

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17
Q

potential long term ocular complications in ANA+ JIA patients

A

synechiae
cataracts
glaucoma
band keratopathy

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18
Q

what is synechiae

A

iris attaches to cornea or attaches to lens

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19
Q

initial pharmacotherapy for JIA

A

intra articular glucocorticoid

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20
Q

second step of therapy for JIA

A 
NSAIDs
motrin = ibuprofen
Naprosyn = naproxen
tolectin = tolmetin
Mobic = meloxicam
Celebrex = celecoxib
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21
Q

third step of therapy for JIA

A

methotrexate

TNF a or abatacept

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22
Q

-cept suffix meaning

A

protected from rapid degradation by attachment to Fc receptor

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23
Q

6 forms of JIA

A
  1. PsA (2-15%)
  2. systemic onset (10-15%) Stills
  3. RF+ polyarticular onset (5-10%)
  4. RF- polyarticular onset (10-30%)
  5. HLA-B27+ oligoarticular onset
  6. ANA+ oligoarticular onset (30-60%)
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24
Q

what is PsA

A

psoriatic arthritis

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25
Q

what is systemic onset JIA (Stills)

A

presents with serious symptoms that resemble leukemia or a horrible infection

26
Q

what is RF+ polyarticular onset JIA

A

adult RA presenting in kids
typically a negative prognosis for joints
tends to occur in slightly older kids

27
Q

what is RF- polyarticular onset JIA

A

children are younger than in RF+ and have a better prognosis for joints

28
Q

what is HLA-B27+ oligoarticular onset JIA

A

ankylosing spondylitis
more common in males around 9-13
peripheral arthritis initially, with back complaints much later

29
Q

how often does PsA accompany psoriasis?

A

25% of the time

30
Q

how often do patients have psoriasis prior to being diagnoses with PsA?

A

70%

31
Q

how often does PsA precede a diagnosis of psoriasis?

A

15%

other 15% coincident onset or undiagnosed psoriasis

32
Q

CASPAR criteria for PsA

A

> 3 points, 99% spec/92% sens

  • 2 pts psoriasis
  • 1 pt past psoriasis or FH
  • 1 pt psoriatic nail changes
  • 1 pt RF-
  • 1 pt dactylitis
  • 1 pt radiographic juxtaarticular new bone
33
Q

where is psoriasis most common

A

scalp, retroaural, EACs
extensor extremities
umbilicus, gluteal cleft/perianal

34
Q

racial predilection of PsA

A

whites 2:1

35
Q

sex of PsA patients?

A

equal overall

males: axial (3:1) and classical (vide infra)
females: RA-like

36
Q

age of onset of psoriasis in PsA

A

mid-teens-20s

37
Q

age of onset of joint complaints in PsA if there was prior skin involvement

A

a decade after skin involvement

38
Q

genetic influences on PsA

A

35-70% monozygotic concordance
12-20% dizygotic concordance
1st degree relatives of PsA 27-50x greater risk

39
Q

specific genes found in PsA

A

HLA-B27 + in only axial pts (50%)

HLA-B38 and B39 in general PsA

40
Q

categories of PsA (not mutually exclusive)

A 
asymmetric, oligoarticular (15-20%)
symmetric, polyarticular (50-60%)
"classical" (2-5%)
isolated axial (2-5%)
arthritis mutilans (5%)
41
Q

asymmetric, oligoarticular PsA

A

associated with dactylitis / ray involvement

42
Q

symmetric, polyarticular PsA

A 
RA like
usually seronegative (95% of the time)
43
Q

classical PsA

A

uncommon
predominant DIP involvement
dactylitis present
nail involvement

44
Q

isolated axial PsA

A

only SI joint involvement (asymmetric)
+/- spinal involvement
syndesmophytes large /nonmarginal

45
Q

what are syndesmophytes

A

vertical bony spurs

like dripping wax down the spine?

46
Q

arthritis mutilans

A

very dysmorphic hands
very little bone growth
can pull fingers out to a normal length, but they shrink back

47
Q

what is enthesitis

A

inflammation of a tendon/ligament insertion into bone

48
Q

what is dactylitis

A

sausage fingers/toes

49
Q

common extraarticular manifestations of PsA

A 
enthesitis
dactylitis
nail pitting
other nail changes (onycholysis, onychodystrophy)
conjunctivitis
acute iritis
50
Q

rare extraarticular manifestations of PsA

A

stomatitis
urethritis
nonspecific colitis
dilation of aortic arch base

51
Q

treatment of PsA

A 
NSAIDs
intraarticular steroids
methotrexate
leflunomide
apremilast
TNFa inhib
anti-IL17
anti-IL12/23
JAK inhibitor
costim blockade
52
Q

use of methotrexate in PsA

A 
oral, 7.5-25 mg once a week
subQ same dosage; better bioavailability
take w 1 mg folic acid daily
can help both skin and joints
not helpful for spine or nails
53
Q

use of leflunomide in PsA

A

pyrimidine antagonist
20 mg qd
side effects similar to mtx
less helpful for skin than mtx

54
Q

use of apremilast in PsA

A

pde4 inhibitor
30 mg bid
approved for skin and joints
excellent safety profile

55
Q

use of TNFa inhibitors in PsA

A

4 subQ doses per week
1 IV dose every 4-8 weeks
more risky/ greater payoff

56
Q

use of anti-IL17 in PsA

A

secukinumab approved for PsA

every 4 weeks subQ after a 5 shot weekly loading phase

57
Q

use of anti-IL12/23 in PsA

A

ustekinumab

every 12 weeks subQ after 2 loading doses 4 weeks apart

58
Q

use of janus kinase inhibitor in PsA

A

tofacitinib

11 mg oral qd

59
Q

drugs to avoid in PsA

A

prednisone

hydroxychloroquine

60
Q

use of abatacept in PsA

A

costimulatory blockade

subQ weekly or IV every 4

61
Q

MAINSTAYS of therpay in PsA

A

glucocorticoids and NSAIDs almost always insufficient

mainstays: mtx and TNFa inhib

MM Test 2 (23 decks)

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