Master the Boards: Rheumatology 1 Flashcards
RA DX needs 4 of the following
- Morning Stiffness lasting >1hr
- Positive ACCP or RF
- Elevated CRP or ESR
- Inflamatory arthritis in 3 or more joints(MCP and PIP common)
- Duration of Sx greater than 6 weeks
Why do RA patients need X-ray or CT prior to intubation
C1-C2 subluxation
MCV in RA anemia
normal
Felty syndrome
RA
Splenomegaly
Neutropenia
Do NSAIDs delay progression of RA
no just help w pain
When to start DMARD and NSAIDs for RA
as soon as Dx is made
SE of Methotrexate
- bone marrow suppression
- pneumonitis
- liver dz
anakinra class
IL-1 receptor antagonist
tocilizumab/sarilumab class
IL-6 receptor antagonist
Rituximab class
CD-20 antibody
Leflunomide class
pyrimidine antagonist similar to methotrexate
Abatacept class
inhibits T cell activation
Infliximab, adalimunab, etanerercept, certolizumab, golimumab class
TNF-a inhibitors
Tests before adding TNF-a onto methotrexate
Hep B and TB
Are TNF-a inhibitors safe in pregnancy
yes
When to use Janus Kinase inhibitors (Tofacitinib)
severe RA not responsive to Methotrexate
Hydroxychloroquine tests
eye exam to check for retinopathy
RA patient acutely ill w severe inflammation tx (bridge)
add on steroids try not to do long term
Best test RA
ACCP, 95% specific
RA pleural effusion glucose level
lowest of all causes of pleural effusions
Most common joint abnormality
OA
length of morning stiffness in OA
less than 30 min
synovial leukocyte count OA
<2000
OA w inadequate pain control with acetaminophen next step
NSAIDS unless contrindicated
