Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK II Final > Johnston: Rheumatoid Arthritis > Flashcards

Johnston: Rheumatoid Arthritis Flashcards

1
Q

Systemic features of RA

A
  • fatigue, fever, anemia
  • elevated ESR and CRP
  • Malaise, myalgia, depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is RF produced by?

A
  • RA synovium

- made by B cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do RF’s do?

A

-fix complement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does complement consumed in RA joint do?

A

-recruits PMN’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the more specific antibody in RA?

A

-Anti Cyclic citrullinated peptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What two lab tests would be most diagnostic for RA?

A
  • RF

- Anti CCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What imaging would we do for RA?

A
  • X rays of the hands and ffet

- CT is more sensitive detecting erosions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx for RA

A
  • Begin NSAID for pain control
  • Early use of DMARD
  • may need low dose of steroid for a few weeks
  • monitor progress and toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when does RA improve?

A

-during preggo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What age does RA happen at?

A

-young adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

in the point system for RA, what kinds of joints give the patient a lot of points towards having RA?

A

-small joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the only part of the axial spine that really gets affected by RA?

A

-C1 and C2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What part of the hand will almost never be involved with RA?

A
  • the PIP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Swan neck

A

-hyperextension of PIP joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Boutonnier

A

-hyperflexion of PIP joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What might we find on the extensor surface of the forearm with RA?

A

-a nodule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What will that nodule on the extensor surface almost always be positive for?

A

-RF!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What will we see in the wrist?

A
  • radial deviation

- ulnar deviation of the fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What will we see in the knees?

A
  • bakers cyst

- popliteal…. may rupture and be painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What will we see in the neck?

A

-C1-2 subluxation… dont force into flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Clinical manifestations of RA

A
  • pain, swelling, warmth in multiple small joints of the hands and feet
  • morning stiffness> one year
  • > 10% have abrupt onset of disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

extraarticular manifestations of RA

A
  • subQ nodules on extensor surface of forearm

- more common in RF positive or anti-CCP positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Pyroderma gangrenosum

A
  • tender reddish purple papule
  • leads to necrotic, non healing ulcer
  • lower extremity
  • poor prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Rheumatoid Vasculitis

A
  • purpura, petechial splinter hemorrhages

- digital infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Heart in RA

A
  • RA is an independent risk factor for CAD

- HF, pericarditis, CAD due to chronic endothelial inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is it called when someone has nodular opacities on their lung x ray from a rheumatoid nodule?

A

-caplan syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What will we see if there is interstitial lung disease?

A

-clubbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

most common thing with lung

A

-pleuritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is caplan syndrome

A

-nodular densities after exposure to coal or silica dust

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When treating someone for RA, what is something that could happen to the patient that would give them keratoconjunctivitis sicca?

A

-Secondary Sjogrens syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What antibodies are associated with salivary gland involvement

A

-Ro and La

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is schirmers test?

A

-when you take a piece of filter paper and put it under their eyelid to see if they will make tears or not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do you treat sjogren’s?

A
  • artificial tears

- remember that sjogrens syndrome is seen in 35% of RA patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the most common manifestation of RA involving the eyes?

A

-keratoconjunctivitis sicca secondary to Sjogrens syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Sjogrens syndrome

A
  • dry everythings
  • primary Sjogrens is associated with SS-A (Ro) and SS-B (La) antibodies
  • treat symptoms
  • anti inflammatory and immunosuppressive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Feltys Syndrome

A
  • RA
  • splenomagalia
  • Neutropenia
  • Fever
  • Anemia
  • Thrombocytopenia
  • RF and anti-CCP positive
37
Q

What happens in RA due to erosion of odontoid process?

A
  • antlantoaxial subluxation

- peripheral neuropathy will result

38
Q

Diagnosis of RA

A

-No single finding on physical exam or lab tests that is pathognomonic

39
Q

Lab findings for RA

A
  • RF positive
  • anti CCP antibody
  • Increased ESR, CRP
  • Anemia
  • Thrombocytosis
  • Low glucose in body fluids
40
Q

Tx of RA

A
  • no known cure
  • Use consultant, PT, OT
  • Articular rest
  • Treat to target
  • Goal is disease remission; possible in 50% of patients if treated early
41
Q

NSAID

A
  • pain relief
  • does not halt disease progression
  • can use with DMARD’s
  • GI toxicity
  • Inhibits COX enzymes/ PGE2, promotes renal sodium exertion
42
Q

Corticosteroids

A
  • use in low doses
  • can use with DMARD
  • Bridge Therapy
  • chronic use many side-effects
43
Q

DMARDs

A
  • Disease modifying anti-rhematic drugs
  • immunosuppressive agent; increase risk of infection
  • use first to minimize damage
  • can halt disease progression in synovium and halt/slow radiographic progression
  • takes 2 to 6 months to exert maximal effect
44
Q

What does Methotrexate do?

A
  • inhibits folic acid
  • recommended as first DMARD for RA/once a week
  • useful in PsA
45
Q

Toxicity for methotrexate

A

-hepatic, myelosuppression, pulmonary

46
Q

when do we not give MTX?

A

-during pregnancy

47
Q

What are the antimalarial agents we can use?

A
  • Hydroxychoroquine
  • need F/U with ophthalmologist
  • can use with MTX and sulfasal
  • Safe in preggo pts
  • Useful in RA
48
Q

Leflunomide

A
  • pyrimidine antagonist
  • rapid excretion with cholestyramine
  • DONT USE WHEN PREGNANT
  • GI/hepatic toxicity/teratogenic
49
Q

Sulfasalazine

A
  • Effective in RA
  • Monitor WBC
  • Can use with MTX
  • Safe in those who are pregnant
50
Q

What the toxicities of all biologics?

A
  • Increased risk of infection
  • reactivation of latent TB
  • Neoplasia
  • MS
  • Autoimmune disease
51
Q

TNF

A
  • pro inflammatory cytokine in RA pathogenesis
  • stimulates synovial cell proliferation and collagenase/ destroy cartilage
  • Increase inflammation
52
Q

Anti TNF agents

A
  • Etanercept
  • Infliximab
  • Adalimumab
  • rituximab
53
Q

Managing RA

A
  • define extent of joint and extra-articular involvement
  • full dose of NSAID
  • Early use of DMARD
  • Add a biologic agent
  • low dose steroids
  • adequate pain management
  • monitor progress/toxicity
54
Q

What are the spondyloarthropies (SpA)

A
  • Ankylosing spondylitis
  • Reactive Arthritis
  • Psoriatic Arthritis
  • Enteropathic arthritis (EA)
  • Undifferentiaed : doesn’t fit into diagnostic categories, but shares clinical features
55
Q

Where do seronegative spondyloarthropaties usually happen?

A

-the spine, SI joints

56
Q

What is enthesitis?

A
  • inflammed tendon insertion into bone

- immune susceptibility to Allele B27

57
Q

What is spondylitis

A

-inflammation of vertebrae

-

58
Q

what is spondylolisthesis

A

-anterior displacement of a vertebral body relative to the adjacent vertebral body below

59
Q

what si spondylolysis

A

-defect of the portion of bone between the inferior and superior articular process of vertebrae

60
Q

What is reactive arthritis formerly known as ?

A

-Reiter’s syndrome

61
Q

What are spondyloarthropathies?

A
  • rheumatic disorders
  • axial skeleton, peripheral joints
  • HLA B27 assocated with extra-articular manifestations
62
Q

What are the big spondyloarthropathies that are associated with HLA B27?

A

-Ankylosing spondylitis and Reactive Arthritis

63
Q

If you think someone has ankylosing spondylitis, what do you test for?

A

-HLA B27

64
Q

Ankylosing spondylitis

A
  • HLA B27
  • most common inflammatory disorder of axial skeleton
  • 2nd and 3rd decade so pretty young!
65
Q

clinical manifestations of ankylosing spondylitis

A
  • low back pain>3 months
  • morning stiffness, improved with exercise, worse with rest
  • fatigue, weight loss, and fever
  • symmetrical SI joint pain, loss of mobility/flexibility; arthritis of hips
  • tendonitis, plantar fasciitis/enthesitis
66
Q

what is that extraarticular finding that we see in AS but not in RA?

A
  • Iritis is not found in RA,

- can find iritis in SLE, herpes simplex

67
Q

Physical exam with AS?

A
  • restricted forward flexion and restricted chest expansion (FABERE test
  • if inhalation doesn’t change 5cm, that is restriction
68
Q

labs for AS

A
  • Increase ESR, CRP,
  • HLA B27
  • Anemia of chronic disease
  • Negative RF, ACCP, ANA*
69
Q

Imaging for AS

A
  • AP radiographs of pelvis; bl SI changes
  • erosions of SI joints, psueod sidening, sclerosis, fuses, ankyloses, symmetric
  • Vertebrae will have squaring and shiny corners; sclerosis at edge of vertebral bodies
70
Q

What are syndesmophytes?

A
  • bridging of vertebrae (boney bridges cause ankylosis

- this is freaking BAMBOO SPINE

71
Q

What imaging modality is more sensitive for erosions?

A
  • CT

- MRI detects inflammation before changes seen on S rays or CT though

72
Q

What are some late complications of AS?

A

-restrictive lung disease, compression fractures, cauda equina syndrome

73
Q

What were the key points for AS

A
  • back pain before 40
  • insidious onset
  • > 3months
  • AM stiffness, reduction in spinal mobility
  • improvement with exercise or activity
  • positive family hx
74
Q

Tx of AS

A
  • exercise!!!
  • NSAID
  • TNF inhibitors
  • Non biologics like MTX is good for peripheral arthritis, but not for axial disease
75
Q

Reactive Arthritis

A
  • AI disease
  • asymmetric mono-arthritis or oligo-arthritis in lower extremities
  • may be associated with infection
  • GI: salmonella, shigella, tersinia, campylobacter jejuni
  • GU: Chlamydia trachomatis
  • HLA B27 is present in 75% of ReA and IBD associated arthritis
76
Q

Clinical manifestations of ReA in young men

A
  • arthritis that is asymmetrical, lower extremities (ankles, knees)
  • Enthesitis: achilles tendon/ Plantar fasciitis
  • Dactylitis: sausage digit; finger or toe
77
Q

What is Reiter’s syndrome

A
  • cant see, pee, climb a tree

- Urethritis, arthritis, conjunctivitis, mucocutaneous lesions

78
Q

What might we see on the penis of a man who has reactive arthritis?

A
  • circinate balanitis

- right on the tip… ouch

79
Q

What is Keratoderma blennorrhagica?

A
  • painless eruptions on the feet

- can happen with Reiter’s syndrome

80
Q

What will imaging look like for ReA?

A

SI joint

-asymmetrical

81
Q

Labs for ReA

A
  • same as for AS

- HLA B27

82
Q

ReA tx

A
  • self limited in 6 months
  • NSAID
  • If chronic progression, use DMARD
  • Urethritis; chlamydia, azithromycin or doxycycline
83
Q

Psoratic Arthritis (PsA)

A
  • peak age 40-60
  • presents in 5-20% of pts with psoriasis
  • associated with SI and axial involvement
84
Q

Peripheral arthritis

A
  • may be asymmetric or symmetrical
  • DIP, PIP, MCP, MTP
  • pitting nails
  • Bactylitis and enthesitis
  • may have V1-2
  • PsA flare up may be due to co infection with HIV
85
Q

Which kind of arthritis gave us the pencil in a cup thing on radiograph?

A

-Psoriatic arthritis

86
Q

Enteropathic ARthritis

A
  • arthritis associated with CD or UC
  • axial involvement
  • peripheral arthritis
  • all extra-articular manifestations occur more commonly in CD
87
Q

Extra articular manifestations of EA

A
  • Pyoderma gangrenosum, erythema nodosum
  • Uveitis
  • CD/UC
  • Nephrolithiasis
  • Thromboembolism
  • bone fracture, low bone density
88
Q

What are the basic treatment for SpA

A
  • exercise
  • NSAID
  • Gucocorticoids
  • MTX: only works for peripheral arthritis, not Axial
  • Sulfasalazine- PsA
  • DMARD’s - PsA
  • Antibiotics- Chlamydia urethritis

MSK II Final (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions