Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > RA > Flashcards

RA Flashcards

1
Q

RA - main symptoms + which joints affected?

A

symmetrical
swollen, stiff, painful joints
small joints of hands + feet - wrist, MCP/MTP, PIP (DIP spared)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RA: early signs

A

inflammation, eg:
joints - swollen, boggy, pain on moving
tenosynovitis
bursitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RA: later signs

A

joint damage + deformity:
deviation, subluxation + deformity in hands + feet
rupture of hand extensor tendons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

extra-articular signs of RA

A 
felty's syndrome - RA, splenomegaly + neutropaenia
anaemia
lymphadenopathy
carpal tunnel
osteoporosis
nodules - elbows + lungs
fibrosis
effusion - pericardial + pleural
vasculitis
eyes - scleritis, episcleritis, keratoconjunctivitis sicca
raynauds

FALCON FEVER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what antibodies are seen in RA?

A

anti-CCP - 98%

RhF - 70% (high - severe disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

RA on X-ray

A

soft tissue swelling
osteopaenia (juxta-articular)
decreased joint space

subluxation
erosion of bone (later, periarticular)
carpal destruction (later)

SOD SEC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what can MRI + USS detect in RA?

A 
synovitis + joint effusion
bony erosions (more sensitive than xray)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

treatment of active newly diagnosed RA

A

combo of 2 DMARD + steroid

methotrexate + hydroxychloroquine popular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the role of steroids in RA?

A

rapidly reduce symptoms + inflammation
acute exacerbations
intra-articular or oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what can be used for symptom relief in RA?

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

non-drug management of RA

A

psychological interventions
physio + OT - aids, splints
surgery - pain, function, deformity
management of CV RFs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

RA diagnostic criteria

A 
A-D score, using:
joint involvement (partic small)
serology (RhF + anti-CCP)
acute phase reactants (CRP + ESR)
duration of symptoms (6+ weeks)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

pathophysiology of RA

A

inflammation: over-produced cytokines etc erode cartilage + bone + produce systemic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DMARDs in RA: when + what to use?

A

1st line - start within 3mo of persistent symptoms
can take 6-12wk
combo - methotrexate, sulfasalazine, hydroxychloroquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

main SE of DMARDs

A

immunosuppression - monitor FBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

SEs of methotrexate

A

hepatotoxicity
oral ulcers
pneumonitis

HOP

17
Q

SEs of sulfasalazine

A

rash
oral ulcers
sperm count decreased

ROS

18
Q

hydroxychloroquine

A

irreversible retinopathy - annual opthalmology review

19
Q

biological therapies - when to use?

A

when not responded well to other treatments
give in combo with a conventional DMARD
work faster than cDMARDs

20
Q

TNF-alpha inhibitors - examples + when to use?

A

infliximab, etanercept, adalimumab
give in combo with methotrexate
1st line if failure to respond to DMARDs + a DAS28 > 5.1

21
Q

B-cell depletion - example + when to use?

A

rituximab
use in combo with methotrexate
severe RA where DMARDs + TNF-a blockers failed

22
Q

IL1 and IL6 depletion - example + when to use?

A

tocilizumab
use in combo with methotrexate
when TNF-a + b-cell one have failed/contraindicated

23
Q

drug that disrupts T cell function - example + when to use?

A

abatacept

when no response to DMARDs/other biologics

24
Q

SEs of biological agents

A

serious infection eg reactivation of TB (screen + consider prophylaxis) + Hep B
worsening heart failure
hypersensitivity
injection-site reactions + blood disorders

25
Q

investigations to be requested alongside an RA referral

A

baseline - FBC, liver function, renal function
inflammatory markers - check levels of inflammation
thyroid - in case abnormal thyroid giving joint pain
immunology - RhF, anti-CCP, ANA (may indicate CTD)
plain xrays hands + feet

26
Q

disease activity score

A 
DAS-28 - 28 joints tested
no of swollen 
no of tender
CRP or ESR
global assessment of health from 0-10

< 2.6 - remission
< 3.1 - low activity
> 5.1 - active disease

27
Q

what is tenosynovitis? how does it present?

A

inflammation of fluid-filled sheath (synovium) surrounding a tendon
joint pain, swelling + stiffness

28
Q

what is a bursa + bursitis?

how does it present?

A

inflammation of bursa - fluid-filled sac that acts as a cushion between areas of friction eg bones + overlying tendons
pain, swelling, tenderness

29
Q

RA - investigations

A 
CRP
FBC - normochromic, normocytic anaemia of chronic disease
renal + liver baselines
RhF + anti-CCP
xray hands + feet
referral to rheum
30
Q

RA - management

A

DMARD (1st line methotrexate, sulphasalazine
or leflunomide)
bridging steroids
monthly monitoring til remission/low DA - increase dose if necessary

step up to dual DMARD if not better at 6mo
if still not better + high DA - biological

31
Q

methotrexate - counsel

A 
once a week + separate folic acid
myelosuppression
hepato + renal toxicity rare
pneumonitis + fibrosis rare
cautions - NSAIDs (inhibit excretion)
CI - trimethoprim (folate antagonist)
monitoring - FBC, eGFR, LFT every 4-6wk in first year

MSK (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions