RA + Juvenile Idiopathic Arthritis Flashcards
what are 5 symptoms of rheumatoid arthritis?
morning stiffness
fatigue
low-grade fever
myalgias
decreased energy
what is the most common sign of rheumatoid arthritis?
polyarthritis joint swelling
what are 3 characteristics of RA?
symmetric
in small joints
erosive polyarthritis
what is occasionally seen initially in RA?
monoarticular disease (in one joint)
what is associated with decreased risk of RA?
breastfeeding
what are the 3 most common joints of the hands affected by RA?
PIP
MCP
wrists
what is the most common joint of the feet affected by RA?
MTP
deformity in which the PIP joint is flexed and the DIP joint is hyperextended
boutonniere deformity
which joint is spared in RA?
DIP joint
deformity in which the MCP joint is flexed, PIP is hyperextended, and DIP is flexed.
swan neck deformity
where in the cervical spine is commonly involved in RA?
C1-C2
how does cardiac involvement present in RA?
pericarditis
how does hematologic involvement present in RA?
normocytic normochromic anemia
a patient with RA experiences manifestations of felt’s syndrome. what is this?
splenomegaly with neutropenia
how does ocular involvement present in RA?
keratoconjunctivitis sicca
what extra-articular manifestation is pathognomonic for RA?
subcutaneous rheumatoid nodules
what patients with RA is subcutaneous rheumatoid nodules most strongly associated with?
seropositive patients (+RF)
what are 3 prominent symptoms to indicate RA?
morning stiffness x 1-2 hrs for at least 6 weeks
symmetric swelling of 4+ joints for at least 6 weeks
subcutaneous nodules
what is a hallmark feature of RA?
persistent symmetric polyarthritis of hands and feet
what lab can be done for RA that is nonspecific and may be absent in early disease?
RF
what lab is very specific for RA?
anti-cyclic cirullinated peptide (CCP)
what 3 basic labs should be ordered for RA?
CBC w/diff
CMP
ESR/CRP
what will xrays show in a patient with RA? (4)
erosions
soft tissue swelling
ulnar deviation
joint space narrowing in later disease
what will an ultrasound show in a patient with RA? (2)
erosions
synovial hypertrophy
what is the NSAID rule for treatment of RA?
use only one NSAID at a time
which NSAID can be used to treat RA? what can be used with it to protect gastric mucosa?
naproxen (naprosyn)
PPI
which NSAID is 2nd line for RA and has less risk of GI bleed?
celecoxib
when treatment can be used for pain in RA when NSAIDs are contraindicated?
what’s an ADR?
acetaminophen
liver toxicity
what treatment offers the most effective short-term relief for RA, and is used as a bridge until DMARDS starts working?
corticosteroids
what do corticosteroids help with in RA?
active disease or flare-ups
which corticosteroid can be used for RA?
what’s an alternative if patient doesn’t want to gain weight?
low dose prednisone
intra-articular steroid injection
what is the mainstay of management in RA?
DMARDs
immunosuppressive drugs that reduce M&M by limiting complications, slowing progression of disease, and preserve joint function
DMARDs
how long do DMARDs take to work?
6 weeks or longer
what are the two 1st line DMARDs used for RA?
methotrexate
leflunomide
what is the initial DMARDs of choice for RA?
methotrexate
how is methotrexate used for RA?
once a week
pill OR subcutaneous
3 ADRs of methotrexate?
liver toxicity
renal toxicity
teratogenicity
how is leflunomide used for RA?
daily
4 ADRs of leflunomide?
liver toxicity
teratogenicity
alopecia
bone marrow suppression
what should be monitored when using methotrexate? leflunomide?
liver and renal function
liver function
what are the 2 alternative DMARDs used for RA?
hydroxychloroquine
sulfasalazine
which DMARDs requires eye examination, but is okay to use in pregnant women or women planning to become pregnant?
hydroxychloroquine
what is hydroxychloroquine dosing based on?
weight
what should be checked before treating a patient’s RA with sulfasalazine? why?
G6PD
risk of hemolysis
in which patients should sulfasalazine be avoided? (3)
lupus +
sulfa allergy
aspirin allergy
newer protein drugs used for RA that reduce the signs and symptoms of synovitis
biologics
before starting biologics, what should patients be screened for? (2)
TB with Chest Xray
hepatitis panel
what is the most common type of arthritis seen in kids and teens?
juvenile idiopathic arthritis (JIA)
what criteria must be met to diagnose a patient with CHRONIC Juvenile idiopathic arthritis?
chronic inflammatory arthritis > 6 weeks
what is the age of onset of juvenile idiopathic arthritis?
younger than 16 yrs
what are the 6 types of Juvenile Idiopathic Arthritis?
oligoarthritis
polyarthritis
systemic juvenile idiopathic arthritis
psoriatic
enthesis-related
undifferentiated
the most common JIA that affects 4 or less joints during the duration of the disease
oligoarthritis
a 2 year old patient presents with asymmetrical joint pain in the knees, ankles, and wrists and has uveitis. Dx?
oligoarthritis
what lab will be positive in oligoarthritis? what does it indicate?
ANA
asymptomatic uveitis
JIA that affects more than 5 joints during the first 6 months of disease
polyarthritis
a patient presents with weight loss, fatigue, low fever, and pain in 6 joints. Dx?
polyarthritis
peaks at 1-3 years old and then later in adolescence, has symmetrical distribution affecting larger joints like cervical spine and TMJ. Patient has a negative RF. Dx?
seronegative polyarthritis
what is the least common of all JIA?
seropositive polyarthritis
onset during early adolescence, has symmetrical distribution, can be erosive, and affects large and small joints like the rheumatoid nodules over elbows and achilles. Patient has a positive RF. Dx?
seropositive polyarthritis
a patient presents with arthritis in their joint and a fever for 2 weeks. They also have an erythematous rash that comes and goes. Dx?
systemic JIA
one of the following must be present for a patient to be diagnosed with systemic JIA: (4)
transient erythematous rash
lymphadenopathy
hepatomegaly/splenomegaly
serositis
what is the criteria for psoriatic JIA?
arthritis + psoriasis
OR
arthritis + two:
dactylitis
nail pitting/onycholysis
psoriasis in 1st deg relative
a 3 year old patient presents with chronic uveitis. what do they likely have?
psoriatic JIA
inflammation at site where tendons and ligaments insert into bones and strongly associated with HLA-B27.
enthesis-related JIA
a patient presents with asymmetric peripheral arthritis, anterior uveitis, IBD, and pain in the hip. Dx?
enthesis-related JIA
patient meets criteria for more than one subtype or no subtype
undifferentiated
what will RF+ patients show in xray late in the course of JIA? (2)
joint space narrowing
erosion
what is the best imaging tool to detect early bone erosions in JIA?
ultrasound
what will help make a definitive diagnosis of JIA?
synovial biopsy
what screening test should be done in patients with anterior uveitis?
slit lamp exam (ophthalmological screening)
what is the first line treatment for JIA?
Indomethacin (NSAID)
what is the second line treatment for JIA?
methotrexate (DMARDs)
what can be used to treat JIA if patient does not respond to 3 months of methotrexate?
biologics
what is the treatment for polyarthritis JIA with moderate/severe disease activity?
biologics
what can be used in JIA for severe systemic involvement, bridge therapy for DMARDs, and for acute anterior uveitis?
short-course systemic steroids
what are 3 articular complications associated with JIA?
joint destruction/deformity
limb length discrepancy
growth retardation
what are 2 extra-articular complications associated with JIA?
blindness (chronic anterior uveitis)
pericarditis/pleuritis
what is a common extra-articular complication of systemic JIA?
macrophage activated syndrome
prognosis of JIA?
most resolve by puberty
