CML case 1 and 2: RA and osteoporosis

Question 1

Name 3 risk factors for RA

Answer 1

HLA-DRB1 genes
Female
Smoking

Question 2

The main target for autoimmune processes in RA is _____ tissue

Answer 2

synovial

Question 3

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

Answer 3

Pannus

Question 4

Morning stiffness in RA typically lasts how long?

Answer 4

> 30 minutes

Question 5

Is RA symmetric or asymmetric?

Answer 5

symmetric

Question 6

What joints are commonly affected by RA?

Answer 6

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

Question 7

Classic hand deformities of of RA patients include?

Answer 7

Ulnar deviation of MCP joints
Swan neck deformity
Boutonniere deformity

Question 8

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

Answer 8

True

Question 9

What ocular manifestations are commonly caused by RA?

Answer 9

Keratoconjunctivitis sicca

Scleritis/episcleritis

Question 10

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

Answer 10

True

Question 11

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

Answer 11

Splenomegaly
Anemia
Neutropenia
Thrombocytopenia
Arthritis

Question 12

What is the most specific lab test for RA?

Answer 12

Anti-CCP antibodies

Question 13

Other labs that may be positive in RA include?

Answer 13

RF, ESR/CRP

Question 14

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

Answer 14

Joint space narrowing and erosions

Question 15

What criteria must be met to diagnose RA?

Answer 15

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

Question 16

Treatment for RA?

Answer 16

DMARDs

Rheumatology referral

Question 17

What screening should be done prior to DMARD initiation?

Answer 17

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

Question 18

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

Answer 18

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

Question 19

When are corticosteroids appropriate for RA?

Answer 19

Good bridge while starting DMARD

Can use for flares but not long term

Question 20

Most common DMARD of choice?

Answer 20

Methotrexate

Question 21

Starting dose of methotrexate?

Answer 21

7.5mg PO weekly

Question 22

Patients on methotrexate should be taking what supplement?

Answer 22

Folate

Question 23

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

Answer 23

Osteoporosis

Question 24

Describe a typical osteoporosis patient.

Answer 24

Thin white postmenopausal women

Question 25

Secondary osteoporosis can be due to?

Answer 25

Alcohol Vit D deficiency Meds

Question 26

What is the gold standard for bone density measurement?

Answer 26

Bone densitometry (DXA)

Question 27

A patients T score is -1.0. | When should they get their next bone scan?

Answer 27

5 years

Question 28

A patients T score is -2.5. | When should they get their next bone scan?

Answer 28

In 1-2 years

Question 29

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

Answer 29

Z score

Question 30

T score uses standard deviation from ?

Answer 30

A healthy 30 y.o. patient

Question 31

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

Answer 31

Osteopenia

Question 32

Osteoporosis is defined as a T score below?

Answer 32

-2.5

Question 33

Most important lifestyle modification a patient with osteoporosis can make?

Answer 33

Smoking cessation

Question 34

Recommended daily intake of calcium?

Answer 34

1200mg

Question 35

Recommended daily intake of vitamin D?

Answer 35

800 units

Question 36

What is a good first line therapy for osteoporosis?

Answer 36

Bisphosphonates such as alendronate or risendronate

Question 37

Before starting a bisphosphonate, what should be evaluated?

Answer 37

Calcium, 25-hydroxyvitamin D, Cr

Question 38

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

Answer 38

Trick question - None! | Bisphosphonates are contraindicated in esophageal disorders

Question 39

How would you instruct your patient to take their bisphosphonate?

Answer 39

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

Question 40

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?

Answer 40

You bet

Question 41

What is a weird specific side effect of bisphosphonates?

Answer 41

Osteonecrosis of the jaw

Question 42

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

Answer 42

Calcitonin

Question 43

What is the difference between a kyphoplasty and a vertebroplasty?

Answer 43

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.