RA Flashcards by Catherine Atkinson

A patient with a “shared epitope” and HLA-DRB1 gene most likely has what disease?

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What is the reason females have a higher rate of RA as compared to males?

Estrogen related to TNF

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Which of the following is not a RF for RA?

a. shared epitope
b. male» female
c. smoking
d. ages 25-55

b. male» female

its female»male

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What is the highest age incidence for people with RA?

25-55 age

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________ is the main target for the RA autoimmune process and a _______ is formed from synovial proliferation

synovial tissues, pannus

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What is the pre-clinical stage of RA?

breakdown of self-tolerance

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The pannus invades and destroys ________ & _________

bone and cartilage

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RA is usually abrupt or insidious in onset?

Insidious

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A classic sign of RA is morning stiffness > ______ min?And after what?

greater than 30 min and after prolonged activity

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How can you differentiate RA from OA?

RA: morning stiffness > 30 min after prolonged activity

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Is RA symmetric or asymmetric tender and painful joints?

Symmetric

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What are the mc affected places for RA?

PIP, MCP, MTP, also wrists, ankles, knees

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What joints does ulnar deviation occur in?

MCP

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Hyperextension of PIP and flexion of DIP refers to what RA manifestation?

Swan neck deformity

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Flexion of PIP and extension of DIP refers to what RA manifestation?

Boutinniere deformity

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What are general symptoms of RA?

Fatigue, weight loss, low-grade fever

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A patient has nodules on extensor surfaces Uforearms), over joints and pressure points that are firm and non-tender, what lab do you expect to see on this patient?

RF +

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These are areas where you can get rheumatoid nodules

Forearms, over joints, pressure points, lungs, sclerae, other tissues

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What is a lab that is not specific for RA but is positive in most cases?

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This is a lab that is more sensitive for RA and shows up early in the RA course (often times long before symptoms of RA)?

anti-CCP

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What two labs together indicate more severe RA disease?

Seropositive anti-CCP and RF

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What are ocular manifestations of RA?

keratoconjunctivitis sicca, scleritis/episcleritis, scleromalacia (thinning of sclera bc degenerating)

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Which is NOT a pulmonary manifestation of RA?

a. pleuritis
b. pneumonia
c. pleural effusions
d. rheumatoid nodules
e. interstitial lung disease
d. they are all manifestations

b. pneumonia is not a pulmonary manifestation of RA

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A patient with RA could have which type of cardiac manifestations?

Chronic inflammation increases risk for CV disease because always in a state of inflammation
pericardial effusions
pericarditis

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What is felty syndrome?

SANTA - Splenomegaly - Anemia - Neutropenia - Thrombocytosis (too many platelets in blood) - Arthritis

True or false: A patient with neutropenia can be asymptomatic or have recurrent bacterial infections

True

What is citrullination?

Occurs at sites of inflammation and involved in the pathogenesis of RA

What is seropositive vs seronegative?

Sero positive is when pt has RF and anti-CCP and seronegative is when both are negative

ESR and CRP would be _______ in patietns with RA

elevated

RA and _____ have overlapping symtoms

gout

Synovial fluid in a patient with RA would show what?

Inflammatory effusion, leukocytes 1500-25,000 and PMNs dominate

What type of imaging do you get for RA

Xray but MRI more sensitive. Can also do U/S

Xrays might be normal in the first ______ months of RA

6 months

The most obvious erosion of RA might be the _____

5th MTP

Early on in RA what would the xrays show?

-soft tissue swelling and osteopenia around the joint

Where would you see the earliest changes in RA?

wrists or feet

Later on what would RA xrays show?

joint space narrowing and erosions

In the RA classification criteria, how many points do you have to have to dx RA?

6 points and most pts for lots of involvement in small joints

Can RA be diagnosed without labs?

Yeah there is a criteria that takes into account other things besides labs

What is high on your ddx for RA?

- Gout - Lupus - OA

To diagnose RA, the patient must have inflammatory arthritis affecting ____ joints

greater than or equal to 3

True or false: If a patient is seronegative, you can still diagnose RA if you have excluded other causes and all other characteristics are met

true

How long do a patients RA symptoms have to last for to diagnose it?

greater than or equal to 6 weeks

Early dx and initiation of DMARDs is better for those with RA?

DMARDs

What pretreatment screening is necesscary for those with RA?

- Hep B & C - Baseline CBC, Cr, LFTs, ESR, CRP - Ophthlamic screening - Check for latent TB - Rule out pregnancy - Baseline radiographs

Can NSAIDs be used for monotherapy in RA?

No, not to be used as monotherapy

This med helps with symptoms but does not alter the disease course of RA

Nsaids

What do you use for RA as a bridge while starting a DMARD?

Prednisone

This med is very helpful for symptom relief AND slowing rate of joint damage?

Corticosteroid (pred)

How would you initiate RA treatment?

DMARD + pred (taper 10/7.5/5/2.5) its a 3/2/1 taper also add folate

All patients taking MTHx should be also taking what?

Folic acid (folate) daily or leucovorin calcium weekly

When are biologics used in RA and how do we tell a biologic from a conventional med?

Used for severe disease and are expensive! All end in "cept or umab"

What is the typical starting dose of methotrexate?

7.5 mg PO qday

How soon can you expect to see in an improvement in RA with methotrexate?

2-6 wks

WHat are contraindications of using methotrexate?

a. pregnancy b. liver disease c. heavy etoh use d. severe renal impairment

What are some s/e of methotrexate?

GI upset, stomatitis

WHat two labs do we need to closely monitor in patients taking mthx?

CBC for cytopenias (reduced # of mature blood cells) && LFTs for hepatotoxicity

How are TNF inhibitors administered in RA?

IV or SQ

What is a downfall of taking TNFs for RA?

Much higher rate of serious bacterial infections (especially reactivation of TB)

This med is generally your first choice for TNF?

Enteracept

What must you screen for before starting a TNF inhibitor?

You should follow radiographs for how long with RA?

every 2 years

What are poor prognosis factors for those with RA?

- RF or anti-CCP + - extraarticular manifestations - functional limitation - erosions on radiograph