Rheum - MedEd - rheumatoid arthritis Flashcards
Rheumatoid arthritis - what type of disease and who?
Autoimmune
Females
>45yo
RA - pathophys
Pannus formation –> joint destruction, EROSION
What are some of the components that make up the diagnosis of RA?
1) Joints
2) Morning stiffness
3) Nodules
4) Labs
What type of joints do RA effect? Number? Symmetric?
Small joints - of hand and feet (lots) i.e. crooked, bent fingers = > 3 joints symmetric Spare DIPs!
Describe morning stiffness in RA
> 60 min (OA < 30)
Nodules in RA
Pathognemonic
These are cholesterol on biopsy
Blood tests in RA
CCP is better than RF
CCP more specific for RA
(RF is a inflammatory mediator, if RF is negative, probably not RA)
Need to get both tests, and if one is positive, counts toward diagnosis
Imaging in RA
Erosions on X-ray
Periarticular osteopenia*
Treatment of RA
NSAIDs + DMARDs
Biologics for severe disease
Steroids for flares
NSAIDs for RA
Ibuprofen Meloxicam -Never monotherapy -Don't change course of disease -Need a DMARD
DMARD for RA
Methotrexate for RA
Hydroxychloroquine for lupus
(Other options are leflunomide, sulfasalazine) Should also attempt to combine DMARDs before moving to biologics
1) Methotrexate
2) Leflunomide
3) Add-on hydroxychloroquine
4) Add-on sulfasalazine
If non-erosive, pregnant - use hydroxychloroquine
Biologics for RA
TNF-alpha inhibitors
Infliximab
Rituximab
Etanercept
*Need to be adequately vaccinated before starting on biologic and need to know if exposure/previous TB/lived in TB endemic areas/fungi
If start without testing, TB/fungi will flare!
Steroids for RA
Prednisone for acute flare
Morning stiffness in C1-C2 - what is this?
Get X-ray pre-op
Need a surgery
This is RA
Felty syndrome - what is this?
RA + neutropenia + splenomegaly
