RA Flashcards
What is rheumatoid arthritis (RA)?
A systemic disease characterized by bilateral inflammatory arthritis that usually affects the small joints of the hands, wrists, and feet
RA has a prevalence estimated at 1%–2%, predominantly affecting women until age 60.
At what age does the prevalence of RA equalize between genders?
After age 60
What type of disease is rheumatoid arthritis?
Autoimmune disease with a strong genetic predisposition
What are common symptoms of RA?
- Joint pain and stiffness
- Fatigue
- Warmth, redness, and swelling of the joints
- Symptoms usually have a symmetrical distribution
What laboratory tests are often positive in RA?
- Rheumatoid factor (RF)
- Elevated sedimentation rate
- C-reactive protein
- Anti–cyclic citrullinated peptide antibodies
- Normochromic normocytic anemia
What are some extra-articular manifestations of RA?
- Pulmonary fibrosis
- Vasculitis
- Dry eyes
What is the treatment goal for RA?
To control the inflammatory process leading to relief of pain, maintenance of function, and improved quality of life
What non-pharmacologic treatments are recommended for RA?
- Rest during exacerbation
- Occupational and physical therapy
- Maintenance of a normal weight
- Assistive devices if needed
- Surgery for tendons or joints
What is the preferred initial treatment for DMARD-naive patients with low disease activity?
Hydroxychloroquine
What is the first-line DMARD for patients with moderate to high disease activity?
Methotrexate
What should be monitored to measure treatment response in RA?
- Reduction in the number of affected joints
- Improvement in pain
- Decreased amount of morning stiffness
- Reduction in serologic markers such as RF
- Improvement in quality-of-life scales
True or False: NSAIDs affect disease progression in RA.
False
What is the risk associated with glucocorticosteroids in RA treatment?
Adverse effects such as osteoporosis, infection risk, and cardiovascular disease
What is the recommendation regarding the use of glucocorticosteroids in RA?
Short-term use (less than 3 months) is preferred to long-term use
Which biologic DMARDs are commonly used for severe RA?
- Etanercept
- Infliximab
- Adalimumab
- Certolizumab
- Golimumab
What is the recommended approach for patients with a history of tuberculosis or hepatitis B before starting biologic DMARDs?
Screening for tuberculosis and viral hepatitis is required
note: Immunizations are best given before initiating DMARDs or biologics. A 2-week waiting period is recommended.
Avoid live vaccines while the patient is taking DMARDs or biologics.
Patients with hepatitis B or C, if treated with effective antivirals, are treated the same as patients without hepatitis; however, with untreated disease, DMARDs are preferred to TNF inhibitors.
What dietary supplements are recommended for patients with RA to prevent osteoporosis?
- Calcium
- Vitamin D
- Bisphosphonates if prednisone 5 mg or more daily is prescribed
What comorbid conditions are patients with RA at higher risk for?
- Cardiovascular disease
- Malignancy
- Osteoporosis
Fill in the blank: The initial goal of RA treatment is _______.
[low disease activity]
What is the first line therapy?
Nonbiologic DMARDs are first line.
For DMARD-naive patients with moderate to high
disease activity we use _______ _______ _______
Methotrexate, leflunomide, HCQ and Sulfasalazine
Why oral methotrexate is preferred over subcutaneous?
because of ease of administration and similar bioavailability at
starting doses
For DMARD-naive patients with low disease activity we use _______ _______ _______
Hydroxychloroquine recommended first line because
of low adverse effect profile.
Sulfasalazine recommended over methotrexate and
leflunomide: Sulfasalazine preferred in pregnancy.
Who are candidates for combination DMARD therapy?
Some patients with poor prognostic indicators such as
functional limitation, extra-articular disease, positive RF,
anti–cyclic citrullinated peptide antibodies, or bony
erosions on radiography.
What are biologic DMARDS?
i. Tumor necrosis factor (TNF) inhibitors: Etanercept,
infliximab,adalimumab,certolizumab,golimumab
ii. Non-TNF biologics: Abatacept, anakinra, rituximab,
tocilizumab, sarilumab
iii. Biologic kinase inhibitor: Tofacitinib, baricitinib,
Upadacitinib.
Role of NSAIDS
NSAIDs do not affect disease progression in RA, their anti
inflammatory effect occurs within1–2 weeks of daily dosing, whereas the analgesic effect begins within several hours of administration.
True or False: patient with congestive heart failure, it is recommended to avoid TNF inhibitors.
True
note: Cardiovascular disease(myocarditis and heart failure)causes 40% of all deaths inpatientswithRA.Low-doseaspirin, omega-3fatty
acids, statins, or combination therapy should be considered.
special indications:
Use DMARDs over biologics in melanoma
use rituximab over TNF inhibitors in lymphoproliferative disorders.
Osteoporosis is more common in patients with RA.
Calcium and vitamin D are recommended. In addition,
bisphosphonates should be considered for prevention
if prednisone 5mg or more daily is prescribed.
