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CMLFInal Sem2 > RA > Flashcards

RA Flashcards

1
Q

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

A

RA

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2
Q

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

A

Estrogen related to TNF

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3
Q

Which of the following is not a RF for RA?

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

A

b. male» female

its female»male

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4
Q

What is the highest age incidence for people with RA?

A

25-55 age

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5
Q

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

A

synovial tissues, pannus

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6
Q

What is the pre-clinical stage of RA?

A

breakdown of self-tolerance

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7
Q

The pannus invades and destroys ________ & _________

A

bone and cartilage

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8
Q

RA is usually abrupt or insidious in onset?

A

Insidious

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9
Q

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

A

greater than 30 min and after prolonged activity

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10
Q

How can you differentiate RA from OA?

A

RA: morning stiffness > 30 min after prolonged activity

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11
Q

Is RA symmetric or asymmetric tender and painful joints?

A

Symmetric

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12
Q

What are the mc affected places for RA?

A

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

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13
Q

What joints does ulnar deviation occur in?

A

MCP

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14
Q

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

A

Swan neck deformity

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15
Q

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

A

Boutinniere deformity

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16
Q

What are general symptoms of RA?

A

Fatigue, weight loss, low-grade fever

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17
Q

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?

A

RF +

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18
Q

These are areas where you can get rheumatoid nodules

A

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

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19
Q

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

A

RF

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20
Q

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)?

A

anti-CCP

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21
Q

What two labs together indicate more severe RA disease?

A

Seropositive anti-CCP and RF

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22
Q

What are ocular manifestations of RA?

A

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

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23
Q

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

A

b. pneumonia is not a pulmonary manifestation of RA

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24
Q

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

A
  • Chronic inflammation increases risk for CV disease because always in a state of inflammation
  • pericardial effusions
  • pericarditis
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25
Q

What is felty syndrome?

A

SANTA

  • Splenomegaly
  • Anemia
  • Neutropenia
  • Thrombocytosis (too many platelets in blood)
  • Arthritis
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26
Q

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

A

True

27
Q

What is citrullination?

A

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

28
Q

What is seropositive vs seronegative?

A

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

29
Q

ESR and CRP would be _______ in patietns with RA

A

elevated

30
Q

RA and _____ have overlapping symtoms

A

gout

31
Q

Synovial fluid in a patient with RA would show what?

A

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

32
Q

What type of imaging do you get for RA

A

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

33
Q

Xrays might be normal in the first ______ months of RA

A

6 months

34
Q

The most obvious erosion of RA might be the _____

A

5th MTP

35
Q

Early on in RA what would the xrays show?

A

-soft tissue swelling and osteopenia around the joint

36
Q

Where would you see the earliest changes in RA?

A

wrists or feet

37
Q

Later on what would RA xrays show?

A

joint space narrowing and erosions

38
Q

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

A

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

39
Q

Can RA be diagnosed without labs?

A

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

40
Q

What is high on your ddx for RA?

A
  • Gout
  • Lupus
  • OA
41
Q

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

A

greater than or equal to 3

42
Q

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

A

true

43
Q

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

A

greater than or equal to 6 weeks

44
Q

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

A

DMARDs

45
Q

What pretreatment screening is necesscary for those with RA?

A
  • Hep B & C
  • Baseline CBC, Cr, LFTs, ESR, CRP
  • Ophthlamic screening
  • Check for latent TB
  • Rule out pregnancy
  • Baseline radiographs
46
Q

Can NSAIDs be used for monotherapy in RA?

A

No, not to be used as monotherapy

47
Q

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

A

Nsaids

48
Q

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

A

Prednisone

49
Q

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

A

Corticosteroid (pred)

50
Q

How would you initiate RA treatment?

A

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

51
Q

All patients taking MTHx should be also taking what?

A

Folic acid (folate) daily or leucovorin calcium weekly

52
Q

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

A

Used for severe disease and are expensive!

All end in “cept or umab”

53
Q

What is the typical starting dose of methotrexate?

A

7.5 mg PO qday

54
Q

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

A

2-6 wks

55
Q

WHat are contraindications of using methotrexate?

A

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

56
Q

What are some s/e of methotrexate?

A

GI upset, stomatitis

57
Q

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

A

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

58
Q

How are TNF inhibitors administered in RA?

A

IV or SQ

59
Q

What is a downfall of taking TNFs for RA?

A

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

60
Q

This med is generally your first choice for TNF?

A

Enteracept

61
Q

What must you screen for before starting a TNF inhibitor?

A

TB

62
Q

You should follow radiographs for how long with RA?

A

every 2 years

63
Q

What are poor prognosis factors for those with RA?

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

CMLFInal Sem2 (10 decks)

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