Rheumatoid Arthritis

Question 1

What is Rheumatoid Arthritis?

Answer 1

Autoimmune

Symmetrical, progressive, insidious, Highly inflammatory connective tissue in synovial joints disorder

Question 2

What are early symptoms of RA?

Answer 2

They are systemic and include fatigue, anorexia, weight loss and generalized stiffness

Question 3

What symptoms will you see as RA progresses?

Answer 3

• Pain and worsening stiffness, limited motion, deformity and disability
• morning stiffness- lasting > 60 minutes
• Rheumatoid nodules and Sjogrens Syndrome

Question 4

What syndrome is associated with RA and SLE?

Answer 4

Sjogrens Syndrome

Question 5

Rheumatoid Arthritis has cycles of remission and exacerbation?
True or False

Answer 5

True

Question 6

Characteristics of Sjogrens Syndrome

Answer 6

Ocular and Oral Symptoms

• diminished lacrimal secretions
• burning, gritty, itchy eyes
• decreased tearing
• diminished salivary gland secretion
• Dry, erythematous
• Depapillation
• Photosensitivity

Question 7

In RA what are usually found on the elbows and fingers of patients?

Answer 7

Rheumatoid Nodules that are typically firm and nontender

Question 8

Name the hand deformities in RA

Answer 8

Ulnar drift
Knuckle subluxation
Wrist subluxation
Finger Swan Neck
Finger boutonniere
Z-shaped thumb

Question 9

Primary joints affected in RA

Answer 9

metacarpophalangeal and proximal interphalangeal

Question 10

Herbeden’s nodes are present in RA.

True or False

Answer 10

False, Hebedens nodes are present in OA

Question 11

What Laboratory findings are consistent with RA?

Answer 11

Positive rheumatoid factor(non-specific)
positive anti-CCP antibody(specific)
Elevated ESR and CRP

Question 12

How much rest does a patient having an exacerbation of RA need?

Answer 12

8-10 hours of sleep plus a nap

Question 13

What exercises are recommended for a patient with RA

Answer 13

ROM, to preserve joint motion
Exercise to improve strength ( isometric, isotonic, isokinetic)
Exercise to increase endurance (walking, swimming, and cycling

Question 14

Collaborative Care for RA Patients

Answer 14

Hand/finger splinting
Physical &occupational therapy
Heat( no more than 20 mins) and cold therapy (no more than 10-15 mins)
Nutrition/Dietary therapy if overweight or anorexic

Question 15

What are some non drug options for RA

Answer 15

Biofeedback and cognitive behavior therapy, social support

Question 16

What is the cornerstone for treatment for RA?

Answer 16

Medications

Question 17

What are DMARDs?

Answer 17

Disease modifying anti-rheumatic drugs

Question 18

What do DMARDS do?

Answer 18

• substantially reduce inflammation of RA
• Reduce and prevent joint damage
• Preserve joint structure and function
• Enable a person to continue his/her activities

Question 19

When will you see improvement with methotrexate?

Answer 19

If started early within 3 months of diagnosis you can see improvements in 4-6 weeks

Question 20

When taking hydroxychloroquine for RA improvement will show in 2 day.
True or False

Answer 20

False, improvement with hydroxychloroquine takes 2-3 months

Question 21

What can RA patients take for immediate relief?

Answer 21

NSAIDS, around the clock for several weeks

Question 22

What is the goal for Steroids for a patient with RA

Answer 22

Rapid inflammation suppression, lowest possible dose for shortest period of time possible, can be give PO, IV or directly injected into joint

Question 23

modifiable risk factors for gout

Answer 23

Hyperuricemia
obesity
HTN
HLD
Ischemic cardiovascular disease
DM
CKD
Dietary factors
Alcohol
Medications altering urate balance