E4 Rheumatoid Arthritis Flashcards
2 major cell types associated with pannus
T lymphocytes
macrophages
major cell type associated with synovial fluid
neutrophils
what is the main diagnostic thing we look for in RA?
how many joints are involved
pts are diagnosed with RA if there is a score of __ or more
6
3 most common joints involved in rA
hands
wrists
feet
give a few of the extra articular manifestations of RA
nodules
vasculitis
pulmonary
cardiac
feltys
ocular
when are rheumatoid nodules more common
in erosive disease
how do i know when to treat nodules in RA?
if pt has symptoms
inflammation of small, superficial blood vessels
vasculitis
what serious thing can vasculitis lead to?
necrosis and stasis ulcers
what two things can RA cause in the pulmonary system
pleural effusions
pulmonary fibrosis
what can RA cause in the ocular system?
sjogrens syndrome and itchy dry eyes with inflammation
3 things RA can cause in cardiac system
pericarditis
conduction abnormalities
rare: myocarditis
what tf is feltys syndrome
inflamed spleen and presence of neutropenia
T or F:
RA can also cause thrombocytosis and renal disease
false, renal disease is associated with treatment not RA
what is ESR?
erythrocyte sedimentation rate (lab indicator for RA)
normal ESR
0-20 mm/hr
is ESR decreased or increased in RA?
increased so above 20
normal CRP
0-0.5 (diagnostic criteria for RA)
a CRP > ? can indicate bacterial infection
10
what is RF?
rheumatoid factor, it is an antibody specific for IgM
T or F:
Not all pts with RA diagnosis are RF+
tru
what is CCP/ACPA
auto antibody presence test (this is a new diagnostic method)
what is ANA?
antinuclear antibodies
ANA more indicative of ?
SLE
elevated ANA titers suggest ___________ disease
autoimmune
what is joint aspiration?
evaluating fluid in joint space
what is the turbidity in joint space due to?
WBC count in that space
Joint aspiration:
glucose: _____ to _____ compared to serum
normal to low
i have no idea what this means
hallmark way to diagnose RA?
radiographic changes -> joint space narrowing and erosions of bone
5 classes used in treating RA
NSAIDs
Corticosteroids
DMARDs
Biologics (Anti-TNF)
Biologics (Non-TNF)
T or F:
NSAIDs hinder the progression of RA
false, specifically says DO NOT alter
NSAIDs are typically used in combo with?
DMARDs
Corticos are used for what 2 properties
anti inflam
immunosuppressive
T or F:
corticos are typically used as mono therapy
false, never. combo w/ DMARDs
two bullet points under corticos for “use in ___”
acute flates
pts w/ extra-articular manifestations
T or F:
corticos and DMARDs have steroid sparing effects
false, NSAIDs and DMARDs
which two classes should NEVER be used as monotherapy?
NSAIDs and corticos
T or F:
in regards to NSAIDs, inflammatory dosing is higher than pain dosing
true, 600-800 for inflammation
which NSAID should not be used if pt has a sulfa allergy
celecoxib
corticos are specifically good during ?
acute flares
4 short term cortico adverse effects ***
hyperglycemia
gastritis
mood changes
elevated BP
5 long term cortico adverse effects **
aseptic necrosis
cataracts
obesity
growth failure
osteoporosis
2 baseline monitoring parameters for corticos
BP
BG
what is DMARD
Disease Modifying Anti-Rheumatic Drugs
DMARDs have the potential to decrease/prevent ______ damage & preserve _____ integrity
joint
joint
T or F:
onset of DMARDs is rapid
false, onset of action is delayed
4 DMARDs they want us to know
MTX
sulfasalazine (SSZ)
HCQ
Leflunomide
most predictable benefit
A. MTX
B. sulfasalazine (SSZ)
C. HCQ
D. Leflunomide
A
MOA of MTX
inhibit dihydrofolic acid reductase (inhibits neutrophil adhesion and chemotaxis)
Dose of MTX *
7.5 mg per week po or IM
(up to 15-20 mg- weekly dose can be taken in one day)
onset of mTX
1-2 months
MTX has _______ metabolism with some ______ excretion
hepatic
renal
highlighted hematologic adverse effect for MTX *
bone marrow suppression
2 highlighted GI adverse effects for MTX
N/V/D
stomatitis/mucositis
what do you prescribe with MTX to reduce sxs
1mg/day of folic acid
2 pulmonary AEs of MTX
pneumonitis
fibrosis
3 derm AEs of MTX
rash
urticaria
alopecia
T or F:
avoid MTX in pts with liver dysfunction
true
T or F:
avoid MTX in immunodeficiency
True
MTX CI in CrCl <__
40
5 baseline monitoring for MTX
CXR
CBC
SCr
LFTs
ALbumin
Leflunomide MOA
inhibit de novo biosyn of pyrimidines -> interfering with TK activity -> inhibit cell cycle progression
T or F:
MTX is a prodrug
false, but leflunomide is
T or F:
Leflunomide requires a loading dose
true
half life of leflunomide
14-16 days damn
use caution when giving MTX and ______ together b/c liver toxicity
leflunomide
5 AEs leflunomide
diarrhea
rash
alopecia
LFTs
teratogenicity
3 monitoring things for leflunomide
CBC
SCr
LFT
MOA of sulfasalazine
inhibit IL-1
T or F:
Sulfasalazine is a prodrug
true, cleaved in colon to sulfapyridine and 5-ASA
unique AE of sulfasalazine (SSZ)
photosensitivity from sulfa component
3 monitoring parameters for SSZ
CBC
SCr
LFT
T or F:
HCQ is more effective in treatment than leflunomide
false
HCQ MOA
modification of cytokine infiltration in joint
unique AE of HCQ
retinal toxicity
T or F:
take HCQ with food
true, relives GI sxs
only monitoring thing for HCQ
vision exam
biologic DMARDs
TNF neutralizers
etanercept
infliximab
adalimumab
golimumab
certolizumab
