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M2F > RA > Flashcards

RA Flashcards

1
Q

what is RA?

A
  • autoimmune, chronic, systemic
  • infl dz, symmetrical
  • targets synovial tissues, diarthrodial tissues
  • polyarthritis
  • extra-articular features
  • idiopathic
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2
Q

RA- systemic features

A
  • fatigue, fever, anemia
  • elevated ESR, CRP
  • constitutional sx’s- malaise, myalgia, depression
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3
Q

RA- immunopathogenesis

A
  • RF produced by RA synovium
  • RF’s fix complement- recruit PMN’s
  • CCP ab’s
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4
Q

RA- pathophysiology

A
  • genetic factors (1/3 of pts)- inc risk of severe RA
  • infiltration of leukocytes, cytokines, macrophages- act T cells
  • B cells prod autoab’s
  • pannus formation
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5
Q

RA- imaging?

A
  • Xrays- hands of feet

- CT- more sensitive detecting erosions

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6
Q

RA- tx

A
  • NSAID- for pain control
  • DMARD
  • low dose steroid for a few wks
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7
Q

RA- epidemiology

A
  • F 2-3X > M; 30-60 yo
  • Native Ams- 5%
  • improves during pregnancy
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8
Q

why is RA important?

A
  • significant mortality- CAD, HF due to endo damage from chronic infl
  • young adults- peak incidence
  • disables pts
  • no perfect tx
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9
Q

mortality assoc w RA

A
  • infection (immunosuppressive drugs)
  • renal dz
  • GI dz
  • HD
  • malignancy
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10
Q

RA classification criteria

A

Aat least 1 joint w clinical synovitis

  • joint involvement- mult, small joints
  • serology- RF, ACCP
  • CRP and ESR
  • duration of sx’s (>6 wks)
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11
Q

Articular manifestations of RA

A
  • diarthrodial synovial joint
  • starts in hands and feet- MCP, PIP, MTP
  • later larger joints
  • C1-C2
  • inc risk osteoporosis
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12
Q

Hands

A
  • DIP almost never involved
  • swan neck
  • boutonniere
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13
Q

rheumatoid nodules

A
  • elbow

- always RF +

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14
Q

RA- radiographic progression

A
  • bony erosions
  • feet- MTP
  • wrist- radial deviation; carpal tunnel syndrome
  • knee- Bakers cyst (popliteal)
  • C1-2
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15
Q

PE

A
  • tenderness, swelling, warmth, erythema fever
  • wt loss, anorexia
  • symmetrical joint involvement
  • infl at least 6 wks
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16
Q

Extra-articular manifestations

A
  • more common in RF or ACCP +
  • subcutaneous nodules (elbow)
  • Pyoderma gangrenosum
  • rheumatoid vasculitis
  • HF, pericarditis, CAD (chronic endo infl)
  • lungs
  • secondary sjogrens syndrome
17
Q

Pyoderma gangrenosum

A
  • tender reddish purple papule

- leads to necrotic, non-healing ulcer

18
Q

Rheumatoid vasculitis

A

-purpura, petechial, splinter hemorrhages, digital infarct

19
Q

RA- lungs

A
  • pleuritis most common
  • nodules, interstitial lung dz
  • pulm fibrosis
20
Q

Caplan syndrome

A

-nodular densities after exposure to coal or silica dust (pneumoconiosis) + RA

21
Q

dry eyes/mouth- rule out what?

A
  • SLE
  • AIDS assoc keratoconjunctivitis
  • vit A def
22
Q

Sjogren’s syndrome- tests?

A
  • Ro/SS-A; La/SS-B
  • schirmer’s test (filter paper under eyelids- collects tears)
  • slit-lamp exam
23
Q

Sjogren’s syndrome- tx

A
  • lubrication w artificial tears

- oral hygiene

24
Q

Sjogren’s syndrome and RA

A
  • SS seen in 35% of RA pts

- keratoconjunctivitis sicca (dry eyes)

25
Q

Feltys syndrome

A
  • RA
  • splenomegaly
  • neutropenia (<2000), anemia, thrombocytopenia
  • fever
  • RF and Anti-CCP +
26
Q

RA- other joints

A
  • atlantoaxial subluxation- erosion of odontoid process

- peripheral neuropathy

27
Q

Dx of RA

A

-no SINGLE finding on PE or lab test is pathognomonic

28
Q

RA- lab

A
  • RF +; Anti-CPP ab (15-20% of RA pts are neg)
  • ESR and CRP inc
  • anemia, thrombocytosis, leukopenia
  • ANA+ (30%)
  • hyperglobulinemia
  • low gluc in body fluids
  • synovial fluid- 2/3 PMN’s; WBCs 5000-100,000
29
Q

RA- tx

A
  • articular rest
  • goal is disease remission (50% of pts if tx’ed early)
  • NSAIDs- for pain relief- GI toxicity
  • corticosteroids- bridge tx!! (flare therapy)
  • DMARDs- immunosuppressive- inc risk of infection- takes 2-6 months
30
Q

RA tx- non-biologics

A
  • Methotrexate (inhibits folic acid)- monitor labs; toxicity- hepatic, myelosupression, pulm; dont give during pregnancy
  • Hydroxychloroquine (antimalarial)- safe in pregnant pts
  • Leflunomide (pyrimidine antagonist)- dont use w pregnant!!!
  • Sulfasalazine
31
Q

RA tx- biologics- toxicity

A
  • inc risk of infection
  • react of latent TB!
  • neoplasia
  • MS
  • autoimmune dz
32
Q

RA tx- biologics

A

Anti- TNF alpha (pro-infl cytokine)

  • Etanercept
  • Infliximab
  • Adalimumab
  • Rituximab
33
Q

Managing RA

A
  • NSAID
  • DMARD
  • add biologic agent
  • low dose steroids- flares/bridge

M2F (15 decks)

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