RA2 Flashcards

1
Q

Classically in RA, the initial radiographic finding is

A

periarticular osteopenia.

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2
Q

Other findings on plain radiographs include:

A
  • soft tissue swelling
  • symmetric joint space loss
  • subchondral erosions, most frequently in the wrists and hands (MCPs and PIPs) and the feet (MTP)
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3
Q
  • offers the gene sensitivity for detecting synovitis and joint effusions, as well as early bone and bone marrow changes.
  • These soft tissue abnormalities often occur before osseous changes are noted on x-ray.
A

MRI

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4
Q

Presence of ___ has been recognized to be an early sign of inflammatory joint disease and can predict the subsequent development of erosions on plain radiographs as well as MRI scans.

A

bone marrow edema

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5
Q
  • has the ability to detect more erosions than plain radiography, especially in easily accessible joints.
  • It can also reliably detect synovitis, including increased joint vascularity indicative of inflammation.
A

Ultrasound, including power color Doppler

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6
Q

as many as 10% of patients with inflammatory a fulfilling ACR classification criteria for RA will undergo a spontaneous remission within __ (particularly
seronegative patients)

A

6 months

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7
Q

As measured by the Health Assessment Questionnaire (HAQ), shows gradual worsening of disability over time in the face of poorly controlled disease activity and disease progression.

A

Disability

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8
Q

overall mortality rate in RA is two times greater than the general population, with ___being the most common cause of death followed by infection

A

ischemic heart disease

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9
Q

is the main driver of joint damage and is the most important cause of functional disability in the early stages of disease.

A

Joint inflammation

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10
Q

Several developments during the past two decades have changed the therapeutic landscape in RA. They include :

A

(1) the emergence of methotrexate as the disease-modifying antirheumatic drug (DMARD) of first choice for the treatment of early RA;
(2) the development of novel highly efficacious biologicals that can be used alone or in combination with methotrexate; and
(3) the proven superiority of combination DMARD regimens over methotrexate alone. The medications used for the treatment of RA may be divided into broad categories: nonsteroidal anti-inflammatory drugs (NSAIDs); glucocorticoids, such as prednisone and methylprednisolone; conventional DMARDs

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11
Q
  • adjunctive agents for management of symptoms uncontrolled by other measures
  • exhibit both analgesic and anti-inflammatory properties
  • exhibit both analgesic and anti-inflammatory properties
  • chronic use should be minimized due to the possibility of side effects, including gastritis and PUD disease as well as impairment of renal function
A

NSAIDs

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12
Q
  • may be administered in low to moderate doses to achieve rapid disease control before the onset of fully effective DMARD therapy
  • a 1- to 2-week burst may be prescribed for the management of acute disease flares, with dose and duration guided by the severity of the exacerbation
A

GLUCOCORTICOIDS

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13
Q

Chronic administration of low doses of ___ may be also warranted to control disease activity in px w/ an inadequate response to DMARD therapy

A

prednisone

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14
Q

may be necessary for treatment of severe extraarticular manifestations of RA, such as ILD

A

High-dose glucocorticoids

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15
Q

intraarticular injection of an intermediate-acting glucocorticoid

A

triamcinolone acetonide

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16
Q

treatment may be appropriate for
primary prevention of glucocorticoid-induced osteoporosis

A

bisphosphonate

17
Q
  • DMARD of choice for the treatment of RA and is the anchor drug for most combination therapies
  • stimulate adenosine release from cells, producing an anti-inflam effect
A

METHOTREXATE

18
Q
  • inhibitor of pyrimidine synthesis
  • appears similar to that of methotrexate
  • shown in well-designed trials to be effective for the treatment of RA as monotherapy or in combination with methotrexate and other DMARDs
A

LEFLUNOMIDE

19
Q
  • similar to the other DMARDs in Its slow onset of action
  • has not been shown to delay radiographic progression of disease and thus Is not considered to be a true DMARD
  • In clinical practice, generally used for treatment of early, mild disease or as adjunctive therapy in combination with other
A

Hydroxychloroquine

20
Q

particularly challenging to treat because some of the DMARDs used for the treatment of RA are associated with pulmonary toxicity, such as methotrexate and leflunomide.

A

RA-ILD

21
Q

High doses of corticosteroids and adjunctive immunosuppressive agents, such as azathioprine, mycophenolate mofetil, and rituximab have been used for treatment of

A

RA-ILD

22
Q

Oral Triple therapy for RA

A
  • Methotrexate
  • sulfasalazine
  • hydroxychloroquine
23
Q

A clinical state defined as low disease activity is the optimal goal of therapy, although most patients never achieve complete of it despite every effort to achieve it.

A

REMISSION

24
Q

as the total absence of all articular and extraarticular inflammation and immunologic activity related to RA.

A

Complete remission

25
Q

A patient may be considered in remission if he or she

A

(1) meets all of the clinical and laboratory criteria
or
(2) has a composite SDAI score of <3.3 The SDAI is calculated by taking the sum of a tender joint and swollen joint count (using 28 joints), px global assessment (0-10 scale), physician global assessment (0-10), and CRP (in mg/dL).

26
Q

Provisional Definition of Remission in Rheumatoid Arthritis

A

At any time point, patient must satisfy all of the following:
- Tender joint count <1
- Swollen joint count <1
- Patient global assessment <1(on a 0-10 stale)

OR

At any time point, px must have a simplified disease activity index score of <_ 3.3

27
Q

all patients with RA should receive a prescription for

A

exercise and physical activity

28
Q

Dynamic strength training, community-based comprehensive physical therapy, and physical-activity coaching (emphasizing ____ of moderately intensive activity most days a week) have all been to improve muscle strength and perceived health status.

A

30 min

29
Q

SURGERY for RA

A
  • total joint arthroplasty
  • Silicone implants
    ¢ Arthrodesis and total wrist arthroplasty
30
Q
  • Up to 75% of female RA patients will note overall improvement in symptoms during pregnancy, but often will flare after
A

delivery

31
Q

Flares during pregnancy are generally treated with low doses of

A

prednisone

32
Q

Are probably the safest DMARDs to use during pregnancy

A
  • hydroxychloroquine
  • sulfasalazine
33
Q
  • Aging leads to a gradual decline in renal function that may raise the risk for side effects from NSAIDs and some DMARDS
  • is usually not prescribed for patients with a serum creatinine >2 mg/dL.
A

Methotrexate