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Cam's Cards > CML case 1 and 2: RA and osteoporosis > Flashcards

CML case 1 and 2: RA and osteoporosis Flashcards

1
Q

Name 3 risk factors for RA

A

HLA-DRB1 genes
Female
Smoking

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2
Q

The main target for autoimmune processes in RA is _____ tissue

A

synovial

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3
Q

What structure is formed by synovial proliferation, which later invades and destroys bone and cartilage?

A

Pannus

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4
Q

Morning stiffness in RA typically lasts how long?

A

> 30 minutes

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5
Q

Is RA symmetric or asymmetric?

A

symmetric

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6
Q

What joints are commonly affected by RA?

A

PIPJ, MCPJ, wrists, ankles, knees, MTPJ, shoulder

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7
Q

Classic hand deformities of of RA patients include?

A

Ulnar deviation of MCP joints
Swan neck deformity
Boutonniere deformity

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8
Q

T/F? Rheumatoid nodules are almost only in RF positive patients?

A

True

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9
Q

What ocular manifestations are commonly caused by RA?

A

Keratoconjunctivitis sicca

Scleritis/episcleritis

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10
Q

T/F? RA can have pulmonary and cardiac manifestations?

A

True

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11
Q

Felty syndrome is a complication of RA. What are the symptoms

A 
Splenomegaly
Anemia
Neutropenia
Thrombocytopenia
Arthritis
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12
Q

What is the most specific lab test for RA?

A

Anti-CCP antibodies

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13
Q

Other labs that may be positive in RA include?

A

RF, ESR/CRP

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14
Q

Describe x ray findings in a patient who has had untreated RA for 20 years.

A

Joint space narrowing and erosions

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15
Q

What criteria must be met to diagnose RA?

A

Inflammatory arthritis of 3+ joints
Positive RF and/or Anti-CCP
Elevated ESR and/or CRP
duration of 6+ weeks

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16
Q

Treatment for RA?

A

DMARDs

Rheumatology referral

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17
Q

What screening should be done prior to DMARD initiation?

A 
Hep B and C
Baseline labs (CBC, Cr, LFTs)
Ophthalmic screening
TB test
Pregnancy
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18
Q

T/F? NSAIDs help with symptoms of RA and alter the disease course?

A

False - they help with symptoms but do NOT alter the disease course

19
Q

When are corticosteroids appropriate for RA?

A

Good bridge while starting DMARD

Can use for flares but not long term

20
Q

Most common DMARD of choice?

A

Methotrexate

21
Q

Starting dose of methotrexate?

A

7.5mg PO weekly

22
Q

Patients on methotrexate should be taking what supplement?

A

Folate

23
Q

Reduction in bone mass leading to decreased bone strength and increased fracture risk is called?

A

Osteoporosis

24
Q

Describe a typical osteoporosis patient.

A

Thin white postmenopausal women

25
Q

Secondary osteoporosis can be due to?

A

Alcohol
Vit D deficiency
Meds

26
Q

What is the gold standard for bone density measurement?

A

Bone densitometry (DXA)

27
Q

A patients T score is -1.0.

When should they get their next bone scan?

A

5 years

28
Q

A patients T score is -2.5.

When should they get their next bone scan?

A

In 1-2 years

29
Q

Which score is expressed as a standard deviation from age-matched, race-matched, and sex-matched means?

A

Z score

30
Q

T score uses standard deviation from ?

A

A healthy 30 y.o. patient

31
Q

A T score between -1 and -2.5 is classified as?

A

Osteopenia

32
Q

Osteoporosis is defined as a T score below?

A

-2.5

33
Q

Most important lifestyle modification a patient with osteoporosis can make?

A

Smoking cessation

34
Q

Recommended daily intake of calcium?

A

1200mg

35
Q

Recommended daily intake of vitamin D?

A

800 units

36
Q

What is a good first line therapy for osteoporosis?

A

Bisphosphonates such as alendronate or risendronate

37
Q

Before starting a bisphosphonate, what should be evaluated?

A

Calcium, 25-hydroxyvitamin D, Cr

38
Q

Your patient with achalasia develops osteoporosis. Which bisphosphonate would you recommend for her?

A

Trick question - None!

Bisphosphonates are contraindicated in esophageal disorders

39
Q

How would you instruct your patient to take their bisphosphonate?

A

Must be taken 1st thing in the morning on an empty stomach. Take with at least 8oz water. Don’t eat or drink anything else for at least 30 minutes. Also remain upright for at least 30 minutes following administration

40
Q

Your patient has been on alendronate for 5 years. Their BMD has not changed, and they have not had any fractures in the past 5 years.
Is it safe to discontinue the alendronate?

A

You bet

41
Q

What is a weird specific side effect of bisphosphonates?

A

Osteonecrosis of the jaw

42
Q

What drug can be used as an analgesic as well as osteoporotic fracture prophylaxis?

A

Calcitonin

43
Q

What is the difference between a kyphoplasty and a vertebroplasty?

A

Vertebroplasty is just cement in the broken vertebral body.

Kyphoplasty is more invasive because they mess around more trying to get it perfectly level and fix the kyphosis.

Cam's Cards (103 decks)

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