OA, RA, JRA

Question 1

In OA, age ___ and older, ___% display radiographic signs of disease

Answer 1

40 years

90%

Question 2

herberdens nodes

Answer 2

DIP, OA

Question 3

bouchards nodes

Answer 3

PIP, RA, OA

Question 4

age of RA

Answer 4

females 3:1, 40-60 yrs, JRA <16y/o

Question 5

what is a pannus

Answer 5

hyperplastic synovial tissue

Question 6

RA on xray

Answer 6

soft tissue swelling, and juxta articular demineralization

Question 7

Labs in RA

Answer 7

CRP and ESR elevated. RF factor and anti CCP antibodies positive in 70-80% of pts, levels may be low in early disease

Question 8

DMARDS

Answer 8

methotrexate, corticosteroids, antimalerials, lefluonomide, sulfasalazine

Question 9

childhood onset idiopathic arthritis

Answer 9

chronic synovitis and a number of extra-articular manisfestations(fever, rash, wt loss, other organ involvement)

Question 10

childhood onset idiopathic arthritis age/gender

Answer 10

females 2:1. females 1-3 yrs old. males 8-12 yrs old.

Question 11

stills disease

Answer 11

JRA. spiking fever, myalgias, salmon pink maculopapular rash in the evening, minimal articular findings

Question 12

salmon pink maculopapular rash in the evening with a fever

Answer 12

stills disease

Question 13

koebners phenomenon

Answer 13

rash elicited by scatching the skin in susceptible areas. stills disease

Question 14

WBC in OA vs RA

Answer 14

200-300 in OA. 3000-5000 in RA

Question 15

PMNs in OA vs RA

Answer 15

25 in OA. 25-50 in RA

Question 16

asymptomatic uveitis with a positive ANA test

Answer 16

pauciarticular childhood onset idiopathic arthritis

**can lead to blindness, do slit lamp

Question 17

polyarticular childhood onset idiopathic arthritis

Answer 17

symmetric involvement of multiple joints. sx: low fever, fatigue, rhematoid nodules, anemia

Question 18

JRA tests

Answer 18

no specific tests. RF positive in 10%. ESR and CRP may be nml to elevated. xrays similar to RA

Question 19

tx for JRA

Answer 19

NSAIDS and PT and occupational therapy. leflumonide and methotrexated 2nd line.

Question 20

what should u monitor in JRA

Answer 20

growth abnormalities, nutritional deficiencies, school/social impairment

Question 21

JRA prognosis

Answer 21

80% remit. pts with RF positive at greater risk of progressing to disabling arthritis into adulthood

Question 22

In OA, what 3 joints are spared

Answer 22

MCP(except the thumb)

ankle

elbow

Question 23

first line tx for OA

Answer 23

acetaminophen

Question 24

HLA DR4

Answer 24

RA

Question 25

In late cases of RA, you see what with fingers

Answer 25

ulnar deviation of fingers with MCP jt hypertrophy

Question 26

TNF inhibitors, rituximab, leflunomide

Answer 26

2nd line meds for RA

Question 27

what is spared in RA

Answer 27

DIP joints

Question 28

Ulnar deviation

Swan neck deformity

Boutonniere deformity

Answer 28

Ulnar deviation – displacement of the fingers medially

Swan neck deformity – PIP hyperextension with DIP flexion

Boutonniere deformity – PIP flexion with DIP hyperextension

Question 29

So for clinical diagnosis of RA (4)

Answer 29

So for clinical diagnosis

Two or more swollen joints

Morning stiffness lasting more than one hour for at least six weeks

Rheumatoid factors or autoantibodies against ACPA

A negative autoantibody result does not exclude a diagnosis of RA.

Question 30

I came in to see my physician assistant because of…

Poor appetite, Fatigue, Lethargy, Fever

Limping, Pain, Morning stiffness

Systemic ___has a characteristic rash and fever which come an go

Answer 30

JRA

Question 31

most common JRA

Answer 31

pauciarticular

Question 32

low grade fever, fatigue, RHEUMATOID NODULES, anemia

Answer 32

polyarticular JRA