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Maddy - NMSP Exam III > Clin - Rheumatoid Arthritis > Flashcards

Clin - Rheumatoid Arthritis Flashcards

1
Q

what are the systemic features of RA

A
  • fatigue, fever, anemia
  • elevated acute phase reactants (ESR, CRP)
  • constitutional sx - malaise, myalgia, depression
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2
Q

describe the immunopathogenesis of RA

A
  • rheumatoid factor produced by RA synovium B cells
  • rheumatoid factor fixes complement
  • complement is consumed in the RA joint which recruits PMNs
  • produces anti-CCP antibodies
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3
Q

what genes are associated with RA

A

HLA-DR4

DRB1 0401 or 0404

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4
Q

what causes the pannus formation in RA

A

B cells produce autoantibodies, cytokines (TNF-a, IL-1, IL-6)

leads to pro-inflammatory cytokine synovial proliferation, which increases synovial fluid and leads to a pannus that invades cartilage and bone

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5
Q

what labs and imaging would you get for a pt you suspect has RA

A

labs:
- RF
- anti-CCP test
- CRP

imaging:

  • x-ray
  • CT
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6
Q

how does pregnancy affect RA

A

RA improves during pregnancy and flares 4-6 weeks postpartum

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7
Q

what infections have been linked to RA flares

A
  • peridontal dz
  • EBV
  • parvo
  • B19
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8
Q

based on 2010 RA classification criteria, who should be tested for RA

A
  • those who have at least 1 joint with definite clinical synovitis
  • synovitis not better explained by another dz
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9
Q

describe the score based algorithm for joint involvement in RA

A

1 large joint: 1 point

2-10 large joints: 2 pt

1-3 small joints: 2 pts

4-10 small joints: 3 pts

> 10 joints (at least 1 small): 5 pts

a score > 6 = definite RA

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10
Q

describe the score based algorithm for serology in RA

A

negative RF and CCP: 0 pts

low RF or low ACCP: 2 pts

high RF or high ACCP: 3 pts

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11
Q

describe the score based algorithm for acute phase reactants in RA

A

normal CRP and ESR: 0 pts

abnormal CRP and/or ESR = 1

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12
Q

describe the score based algorithm for duration of symptoms in RA

A

< 6 weeks: 0

> 6 weeks: 1

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13
Q

what part of the axial spine is most often affected by RA

A

C1-C2

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14
Q

which joints of the hand are most often affected by RA

A

PIP and MCP

DIP almost never involved

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15
Q

what is always positive when a patient has rheumatoid nodules

A

always RF+

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16
Q

what joints in the feet are affected by RA

A

MTP

17
Q

what is seen in the wrist with RA

A
  • radial deviation

- synovial proliferation that compresses median nerve –> carpal tunnel syndrome

18
Q

what is seen in the knees with RA

A
  • bakers cyst in popliteal region (rupture is painful)
19
Q

what skin findings can occur with RA

A

subcutaneous nodules on extensor surface of forearm

pyroderma gangrenosum

20
Q

describe pyroderma gangrenosum

A

tender reddish purple papule that leads to necrotic, non-healing ulcer

21
Q

what vasculitides can occur with RA

A

rheumatoid vasculitis: purpura, petechial, splinter hemorrhages and digital infarction

22
Q

what cardiac dz processes are associated with RA

A

RA is an independent risk factor for CAD

associated with HF and pericarditis as well

23
Q

what pulmonary issues are associated with RA

A
  • pleuritis (most common)
  • nodules, interstitial lung dz
  • caplan syndrome: nodular densities after exposure to coal or silica dust
  • pulmonary fibrosis
24
Q

keratoconjuctivitis sicca is seen with what dz

A

sjogren’s

dry eyes

25
Q

what antibodies are associated with sjogren’s

A

SS-A (RO) and SS-B (La)

26
Q

what is the treatment for sjogren’s

A

anti-inflammatory and immunosuppression

27
Q

what is felty’s syndrome

A
  • RA
  • splenomegaly
  • neutropenia (< 2000)
  • fever, anemia, thrombocytopenia
  • RF and anti-CCP positive
28
Q

30% of RA patients have positive ______ without having lupus

A

ANA antibody

29
Q

list the disorders that can test false positive for RA

A
  • 1-4% healthy elderly pts
  • viral infections (Hep B and C)
  • SLE
  • polymositis
  • sjogren’s
  • systemic sclerosis
  • lymphoma, myeloma
  • TB, mononucleosis, syphilis, sarcoid
30
Q

what is the first DMARD given for RA

A

methotrexate

31
Q

what is the main side effects of using anti-malarial drugs for RA

A

macular damage to retina, blurred vision, halos, photophobia

Maddy - NMSP Exam III (16 decks)

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