Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rheumatology > Rheumatoid and Osteoarthritis > Flashcards

Rheumatoid and Osteoarthritis Flashcards

1
Q

What joints are involved in Rheumatoid Arthritis?

A

HAND JOINTS

  • MCP
  • PIP (NO DIP)

WRIST

ELBOWS

FOOT

  • MTP
  • Mid-Tarsal
  • Cricoarytenoid

CERVICAL SPINE (Vs Lumbosacral in Osteoarthritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What 2 deformities are seen in RA?

A

Swan-neck= Hyperextesion of PIP with Flexion of DIP

Boutonniere=Flexion of PIP and Extesion of DIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What 2 lipid component is often low in RA?

A

Total cholesterol and HDL are low in RA because of inflammtion of the vessel walls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Low BMI in a patient with RA increase what type of risk?

A

Increase CVD risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which RA med have the lowest risk of hyperlipidemia?

A

Hydroxycholoroquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some extra-articular manifestions of RA?

A
  1. Rheumatoid Nodules-can be seen in internal organs like the heart and lungs, MTX can increase them dramatically.
  2. Rheumatoid Vasculitis: seen in whites with severe longstanding RA and high titer of RF/anti-ccp
  3. Pleural effusion with very low glucose
  4. Caplan Syndrome= Pulm. fibrosis + pulm nodule+ RA
  5. Eye: Kerattoconjunctivitis sica, episcleritis, and scleritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the manifestations of RA Vasculitis?

A
  • Digital arteritis leading to splinter hemorrhages, mononeuritis multiplex (wrist drop/ foot drop)
  • Visceral arteritis can present as MI, bowel ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What other autoimmune disorder can present with RA?

A

Sjogren

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Felty’s syndrome?

A

Seropositive RA+ Neutropenia (<500) + Splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Renal involvement in RA is due to what?

A

AA amyloidosis presenting as nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does the synovial fluid in RA show?

A
  • TURBID fluid (low viscosity vs high viscosity in OA)
  • Increase protein
  • Low Glucoe
  • WBC >2000
  • Decrease complement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the non-biologics used in RA?

A 
Methotrexate (1st line)
Leflunomide
Hydroxychloroquine 
Sulfasalazine 
Minocycline
Azathioprine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Prior to starting Azathioprine what should be checked?

A

Thiopurine methyltransferase should be checked as deficiency can lead to toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the Biological agents?

A

TNF inhibitors:

  • Etanercept
  • Infliximab
  • Adalimumab
Non-TNF Biologics:
Anakinra (anti-IL 1)
Abatacept (T cell costimulation inhibitor)
Rituximab
Tocilizumab, Sarilumab (Anti-IL 6)
Tofacitinib (JAK inhibitors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If RA severity remains moderate to high despite MTX monotherapy how should we escalate therapy?

A 
1. Combining DMARDS
Or
2. TNF inhibitor +/- MTX
Or
3.Non-biologics TNFi +/- MTX

If diseae activity remains high despite this then add Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Anti TNF inhibitors and Abatacept are contraindicated in what scenarios?

A
  1. Acute bacterial infection, URI with fever >101
  2. Latent TB (treat at least 1 month prior to startingand continue while on therapy), If active TB stops TNF and treat the TB
  3. Active VZV
  4. Previously treated lymphoproliferative disease
  5. CHF
  6. Acute hep B/C
  7. Liver disease with Child Pugh B/C
  8. MS or demyelnating disease
  9. No live vaccines during therapy
  10. Flu shot, pneumonccocal, hep B vaccine should be given prior to therapy if needed
17
Q

Methotrexate and Leflunomide are C/I in what?

A
  1. Acute bacterial infection, URI with fever >101
  2. Latent TB (treat at least 1 month prior to startingand continue while on therapy), If active TB stops TNF and treat the TB
  3. Active VZV
  4. Pulmonary Fibrosis (MTX)
  5. Creatine clearance <30 (MTX)
  6. Acute hep B/C
  7. Liver disease with Child Pugh B/C
  8. Myelodysplastic syndrome, Leukopenia, Thrombocytopenia
  9. Pregnant
18
Q

Rituximab is associated with reactivation of what diseases?

A

Hep B (Prophylaxis with tenofovir or entecavir)

Progressive multifocal leucoencephalopthy

19
Q

TNF inhibitors are associated with reactivation of what infections? and cancers?

A

TB
Disseminated histoplasmosis
Hep B

Cancer

  • Lymphoma in children and adolescents)
  • Non-Melanoma skin cancers in adults
20
Q

TNF inhibitors are associated with what systemic side effects?

A 
Cytopenia
CHF
Demyelinating disease
Lupus like syndrome
Hepatotoxicity 
Infusion reaction
21
Q

Which vaccine should be given to RA patient older than 60

A

Zoster vaccine 2 weeks prior to therapy

22
Q

A monoarticular flare in a patient with RA should be approached in what way?

A

as if it is a septic arthritis until proven ortherwise because patients on immunosupressive therapy may not mount a fever or leukocytosis

23
Q

How is RA managed in pregnancy?

A

MTX and LEF are discontinued 90 days prior to conception

NSAID used only during second trimester
Steroid use only after first trimester

Sulfaslazine and Hydroxychloroquine are safe during pregnancy

24
Q

What are the causes of Secondary OA?

A
  • Trauma
  • Metabolic (Hemochromatosis)
  • Endocrine (acromegaly)
  • Inflammatory (OA after RA or ankylosing spondylitis)
25
Q

What are the common sites of OA?

A 
FINGER
-DIP (Herbeden's node)
-PIP (bouchards nodes)
-First MCP joint (classic site in females) (base of thumb)
-first MTP joint
SPINE
-lumbosacral
26
Q

When OA is due to hemochromatosis, which joints are classically involved?

A

Second and Third MCP joints

27
Q

What is the most important modifiable risk factor for OA of the knee?

A

Weight Loss

28
Q

How is knee joint OA diagnosed?

A

Knee pain plus 3 of the following:

  1. Age >50
  2. Crepitus
  3. Stiffness lasting <30 minutes
  4. Bone enlargement
  5. No palpable warmth
29
Q

What is Anserine Bursitis and how does it present and treated ?

A

Constant pain and pain with crossing legs, and while lying in a lateral position. Patients often sleep with a pillow in between their legs

Treated with Rest, NSAIDs, steroid injections

30
Q

What does X-ray show in OA?

A

Joint space narrowing and bony overgrowth

Subchondral bony sclerosis

31
Q

How is OA treated?

A
  1. Hand OA
    - Non-Pharm=Exercise
    - Pharm=Oral NSAID or topical NSAID
  2. Knee OA
    - Non-Pharm=Exercise, Weight loss
    - Pharm=Oral NSAID, topical NSAID, Intraarticular injections
  3. Hip OA
    - Non-Pharm=Exercise, Weight loss
    - Pharm=Oral NSAID, U/S guided Intraarticular injections
32
Q

How does Adult Still’s Disease present?And treated?

A 
Evanecent salmon colored macular rash
Daily high fever
Sore throat
LAD
Myalgia/Arthralgia
Serositis

Lab shows High serum Ferritin level, elevated ESR,

Disease may be self-limited or chronic, it is treated with NSAID and aspirin and if severe steroids can be used

Rheumatology (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions