Lecture 2: RA, Seronegative Arthropathies, and Gout Flashcards
Which predisposing factor incrases the risk for severe RA?
Genetic factors: HLA-DRB4
2010 RA classification criteria includes what 4 categories?
- Joint involvement: # of joints and size (smaller = more points)
- Serology: RF and anti-CCP
- Acute phase reactants: CRP and ESR
- Duration of sx’s: <6 weeks or >6 weeks
Which score using the 2010 RA classification criteria indicates definite RA?
>6/10
Which lab values are used to monitor the tx response in RA?
Acute phase reactants: ESR and CRP
Vertebral involvement of RA has a predilection for which spinal segment?
C1-C2
Which skin manifestation presents as a tender reddish purple papule; leading to a necrotic, non-healing ulcer?
Pyroderma Gangrenosum
RA is an independent risk factor for which CV manifestation?
CAD –> chronic endothelial inflammation - damage
What are 3 toxicities you must consider when using the pyrimidine antagonist, Leflunomide, for tx RA?
GI + Hepatic toxicity + teratogenic!
What is the hallmark of spondyloarthropathy in children?
Enthesitis: inflammation at sites where tendons, ligaments and joint capsule insert into bone
What is the most common inflammator disorder of the axial skeleton?
Ankylosing Spondylitis
Which disease manifestation of the eye can be seen with Ankylosing Spondylitis?
Anterior uveitis = Iritis
Which imaging modality is most sensitive for detecting erosions and which is able to detect inflammation earliest?
- CT = more sensitive for erosions
- MRI = detects inflammation before changes seen on X-ray and CT
What are some of the late complications which may arise with Ankylosing Spondylitis?
- Cauda equina syndrome
- Compression fractures
- Restrictive lung disease
Which PE test can help aid in the diagnosis of Ankylosing Spondylitis?
- Restricted forward flexion = Schober Test: ↓ lumbar spine mobility
- FABER test
- Restricted chest expansion
Which pharmacologic agents can decrease the inflammation of the axial spine and improve mobility in pt’s with Ankylosing Spondylitis?
TNF-alpha blockers: Infliximab, Adalimumab
What are the 3 major arthritic clinical manifestations of Reactive Arthritis?
- Arthritis: asymmetrical, oligo-arthritis, LE’s (ankles and knees)
- Enthesitis: achilles tendon/plantar fasciitis
- Dactylitis: sausage digit; fingr or toe
Uric acid lowering agents i.e., xanthine oxidase inhibitors and uricosuric drugs should be used when?
- Recurrent gouty attacks, tophi, kidney stones, cytotoxic therapy
- Do NOT start during acute gout attack; can precipitate flare
