CML case 1 and 2: RA and osteoporosis Flashcards
Name 3 risk factors for RA
HLA-DRB1 genes
Female
Smoking
The main target for autoimmune processes in RA is _____ tissue
synovial
What structure is formed by synovial proliferation, which later invades and destroys bone and cartilage?
Pannus
Morning stiffness in RA typically lasts how long?
> 30 minutes
Is RA symmetric or asymmetric?
symmetric
What joints are commonly affected by RA?
PIPJ, MCPJ, wrists, ankles, knees, MTPJ, shoulder
Classic hand deformities of of RA patients include?
Ulnar deviation of MCP joints
Swan neck deformity
Boutonniere deformity
T/F? Rheumatoid nodules are almost only in RF positive patients?
True
What ocular manifestations are commonly caused by RA?
Keratoconjunctivitis sicca
Scleritis/episcleritis
T/F? RA can have pulmonary and cardiac manifestations?
True
Felty syndrome is a complication of RA. What are the symptoms
Splenomegaly Anemia Neutropenia Thrombocytopenia Arthritis
What is the most specific lab test for RA?
Anti-CCP antibodies
Other labs that may be positive in RA include?
RF, ESR/CRP
Describe x ray findings in a patient who has had untreated RA for 20 years.
Joint space narrowing and erosions
What criteria must be met to diagnose RA?
Inflammatory arthritis of 3+ joints
Positive RF and/or Anti-CCP
Elevated ESR and/or CRP
duration of 6+ weeks
Treatment for RA?
DMARDs
Rheumatology referral
What screening should be done prior to DMARD initiation?
Hep B and C Baseline labs (CBC, Cr, LFTs) Ophthalmic screening TB test Pregnancy
T/F? NSAIDs help with symptoms of RA and alter the disease course?
False - they help with symptoms but do NOT alter the disease course
When are corticosteroids appropriate for RA?
Good bridge while starting DMARD
Can use for flares but not long term
Most common DMARD of choice?
Methotrexate
Starting dose of methotrexate?
7.5mg PO weekly
Patients on methotrexate should be taking what supplement?
Folate
Reduction in bone mass leading to decreased bone strength and increased fracture risk is called?
Osteoporosis
Describe a typical osteoporosis patient.
Thin white postmenopausal women
Secondary osteoporosis can be due to?
Alcohol
Vit D deficiency
Meds
What is the gold standard for bone density measurement?
Bone densitometry (DXA)
A patients T score is -1.0.
When should they get their next bone scan?
5 years
A patients T score is -2.5.
When should they get their next bone scan?
In 1-2 years
Which score is expressed as a standard deviation from age-matched, race-matched, and sex-matched means?
Z score
T score uses standard deviation from ?
A healthy 30 y.o. patient
A T score between -1 and -2.5 is classified as?
Osteopenia
Osteoporosis is defined as a T score below?
-2.5
Most important lifestyle modification a patient with osteoporosis can make?
Smoking cessation
Recommended daily intake of calcium?
1200mg
Recommended daily intake of vitamin D?
800 units
What is a good first line therapy for osteoporosis?
Bisphosphonates such as alendronate or risendronate
Before starting a bisphosphonate, what should be evaluated?
Calcium, 25-hydroxyvitamin D, Cr
Your patient with achalasia develops osteoporosis. Which bisphosphonate would you recommend for her?
Trick question - None!
Bisphosphonates are contraindicated in esophageal disorders
How would you instruct your patient to take their bisphosphonate?
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
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?
You bet
What is a weird specific side effect of bisphosphonates?
Osteonecrosis of the jaw
What drug can be used as an analgesic as well as osteoporotic fracture prophylaxis?
Calcitonin
What is the difference between a kyphoplasty and a vertebroplasty?
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.
