Clin: RA, Seronegative Arthropathies, and Gout Flashcards
Which skin manifestation presents as a tender reddish purple papule; leading to a necrotic, non-healing ulcer?
Pyroderma Gangrenosum
What are 3 toxicities you must consider when using the pyrimidine antagonist, Leflunomide, for tx RA?
GI + Hepatic toxicity + teratogenic!
Vertebral involvement of RA has a predilection for which spinal segment?
C1-C2
Which lab values are used to monitor the tx response in RA?
Acute phase reactants: ESR and CRP
Which predisposing factor incrases the risk for severe RA?
Genetic factors: HLA-DRB4
What is the most common inflammator disorder of the axial skeleton?
Ankylosing Spondylitis
Which score using the 2010 RA classification criteria indicates definite RA?
>6/10
Uric acid lowering agents i.e., xanthine oxidase inhibitors and uricosuric drugs should be used when?
- Recurrent gouty attacks, tophi, kidney stones, cytotoxic therapy
- Do NOT start during acute gout attack; can precipitate flare
RA is an independent risk factor for which CV manifestation?
CAD –> chronic endothelial inflammation - damage
What are the 3 major arthritic clinical manifestations of Reactive Arthritis?
- Arthritis: asymmetrical, oligo-arthritis, LE’s (ankles and knees)
- Enthesitis: achilles tendon/plantar fasciitis
- Dactylitis: sausage digit; fingr or toe
Which PE test can help aid in the diagnosis of Ankylosing Spondylitis?
- Restricted forward flexion = Schober Test: ↓ lumbar spine mobility
- FABER test
- Restricted chest expansion
Which pharmacologic agents can decrease the inflammation of the axial spine and improve mobility in pt’s with Ankylosing Spondylitis?
TNF-alpha blockers: Infliximab, Adalimumab
What are some of the late complications which may arise with Ankylosing Spondylitis?
- Cauda equina syndrome
- Compression fractures
- Restrictive lung disease
2010 RA classification criteria includes what 4 categories?
- Joint involvement: # of joints and size (smaller = more points)
- Serology: RF and anti-CCP
- Acute phase reactants: CRP and ESR
- Duration of sx’s: <6 weeks or >6 weeks
Which imaging modality is most sensitive for detecting erosions and which is able to detect inflammation earliest?
- CT = more sensitive for erosions
- MRI = detects inflammation before changes seen on X-ray and CT
Which disease manifestation of the eye can be seen with Ankylosing Spondylitis?
Anterior uveitis = Iritis
What is the hallmark of spondyloarthropathy in children?
Enthesitis: inflammation at sites where tendons, ligaments and joint capsule insert into bone
