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864 > RA Pre-Lecture > Flashcards

RA Pre-Lecture Flashcards

1
Q
  • ___ disease
  • ___ joint involvement
  • Most common systemic inflammatory disease
A
  • chronic
  • symmetrical
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2
Q

EPIDEMIOLOGY

Age
– Occurs at any age
– Onset is usually between ___ - ___ years
– Shortens lifespan by 3 to 18 years

Sex
– ___ > ___ (6:1 for ages 14-45)

Race
– No discrimination

A
  • 30-50
  • female, male
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3
Q

MHC

Major Histocompatibility Complex

HLA: Human Lymphocyte Antigen typing
– HLA-DR4
– HLA-DR1

TAKE HOME MESSAGE:
– Consider possibility of a ___ etiology/redisposition

A

genetic

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4
Q

RA Progression

over time
inflammation ___ and disability ___

A
  • decreases
  • increases
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5
Q

Prodromal Effects

  • fatigue
  • weakness
  • loss of ___
  • joint pain
  • low grade ___
  • stiffness + muscle ache -> joint ___
A
  • appetite
  • fever
  • swelling
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6
Q

DIAGNOSTIC CRITERIA

  • ___ involvement
  • serology
  • duration of symptoms
  • ___ phase reactants
  • diagnosed with RA if there is a score of __ or more
A
  • joint
  • acute
  • 6
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7
Q

JOINT INVOLVEMENT

Most Common Joints:
- ___ , ___ , and ___

May Involve:
- Elbows
- Shoulders
- Hip
- Knees
- Ankles

A
  • Feet
  • Wrists
  • Hands
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8
Q

EXTRA-ARTICULAR MANIFESTATIONS

A
  • rheumatoid nodules
  • vasculitis
  • pulmonary
  • ocular
  • cardiac
  • Felty’s
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9
Q

RHEUMATOID NODULES

Common: hands, elbows, forearms ( ___ points)

More common in ___ disease

20% of patients are affected

Asymptomatic = ___ intervention

A
  • pressure
  • erosive
  • NO
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10
Q

VASCULITIS

Inflammation of small, superficial blood vessels

Depends upon duration of disease

Stasis ulcers

Infarction -> ____

A

necrosis

fingie turin black

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11
Q

PULMONARY

Pleural effusions

Pulmonary ___

Nodules

Rare: interstitial ___ or arteritis

A
  • fibrosis
  • pneumonitis
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12
Q

OCULAR

___ sicca
- Itchy, dry eyes + inflammation
- ___ Syndrome (KS + RA)

Inflammation: sclera, episclera, cornea

Nodules

A
  • Keratoconjunctivitis
  • Sjogrens
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13
Q

CARDIAC

Increased risk of CV ____

Pericarditis

___ abnormalities

Rare: myocarditis

A
  • mortality
  • mortalityConduction
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14
Q

FELTY’S

  • ___ megaly
  • Neutropenia
A
  • Splenomegaly
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15
Q

Other EXTRA-ARTICULAR MANIFESTATIONS

Lymphadenopathy

___ disease (associated with treatment)

Thrombocytosis

Anemia

A

renal

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16
Q

LABORATORY INDICATORS

  • Anemia
  • Thrombocytosis
  • ___
  • ___
  • RF
  • Anti-CCP/ACPA
  • ANA
  • Joint ___
  • Radiographic findings
A
  • CRP
  • ESR
  • aspirations
17
Q

ERYTHROCYTE SEDIMENTATION RATE (ESR)

  • ___
  • Normal = 0 – 20 mm/hr
  • Elevated in RA (> 20)
A
  • Non-specific
18
Q

C- REACTIVE PROTEIN (CRP)

  • Normal: 0.0 – 0.5 mg/dL
  • positive -> > 0.5 mg/dL
  • > 10 mg/dL can indicate ___
A

bacterial infection

19
Q

RHEUMATOID FACTOR (RF)

  • Antibody specific for ____
  • Not all patients with RA diagnosis are RF+ (60-70% are RF+)
A
  • IgM
20
Q

ANTI-CCP/ACPA

  • High ___
  • Present ___ in disease
  • Predictive value for erosive disease
  • Marker of ___ prognosis
A
  • specificity
  • earlier
  • poor
21
Q

ANTINUCLEAR ANTIBODIES (ANA)

  • Elevated titers suggest ___ disease
  • More indicative of SLE
  • Reported as a titer
A
  • autoimmune
22
Q

JOINT ASPIRATION

  • ___
  • WBC: 5,000 – 50,000/ mm3
  • Glucose: normal to ___ compared to serum
A
  • Turbid
  • low
23
Q

RADIOGRAPHIC CHANGES

  • Joint space ___
  • ___ of bone
A
  • narrowing
  • erosions
24
Q

POOR PROGNOSIS

PHYSICAL FACTORS
- Extra-articular manifestations
- Elevated ___ and ___
- High titers of ___
- Elevated ___ / ___
- Erosions on X-Ray
- Duration of disease
- Swelling of > ___ joints

A
  • ESR, CRP
  • RF
  • anti-CCP/ACPA
  • 20
25
Q

DIFFERENCES FROM OA

RA
- any age
- systemic involvement
- ESR: elevated
- inflammation: present
- joint involvement: ___ : symmetric
- am stiffness > ___
- osteophyte: absent
___: often present
- RF: frequently positive
- subcutaneous nodules: frequently present
- swelling: diffuse symmetric
- malaise, fatigue, musculoskeletal pain, fever

A
  • bilateral
  • 1 hour
  • pannus
26
Q

PHARMACOLOGIC TREATMENT

(5)

A

NSAIDs
Corticosteroids
DMARDs
Biologic Agents Anti-TNF
Biologic Agents Non-TNF

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