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clin med lab 2 - exam 1 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

what genes are associated w. RA

A

HLA-DRB1

PTPNN22

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2
Q

RA involves more efficient __ cells

that produce __

A

T cells

autoantibodies

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3
Q

3 rf for RA

A

female

smoker

25-55 yo

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4
Q

RA pathophys involves the formation of a __

which invades and destroys __

A

panus

bone and cartilage

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5
Q

what happens in the preclinical stage of RA

A

breakdown of tolerance

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6
Q

3 possible triggers for RA

A

bacterial antigens

viral antigens

smoking

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7
Q

RA involves proliferation of

A

synovium

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8
Q

RA usually has __ onset

with morning stiffness lasting >__

especially after __

A

insidious (chronic)

30 minutes

prolonged activity

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9
Q

RA involves __ swelling of joints

A

symmetric

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10
Q

RA is __articular

A

poly

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11
Q

joints mc affected by RA

A

lots of little joints:

PIP

MCP

wrists

ankles

MTP

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12
Q

RA gets __ w. activity

and OA gets __ w. activity

A

worse

better

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13
Q

hand manifestations of RA (3)

A

ulnar deviation of MCP joints

swan neck deformity

boutonniere deformity

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14
Q

hyperextension of PIP

flexion of DIP

A

swan neck deformity

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15
Q

flexion of PIP

extension of DIP

A

boutonniere deformity

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16
Q

extraarticular sx of RA (5)

A

fatigue, wt loss, low grade fever

rheumatoid nodules

vasculitis

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17
Q

what is this showing

A

rheumatoid nodules

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18
Q

what do you think when you see rheumatoid nodules

A

pt is almost surely RF (+)

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19
Q

where are RA nodules commonly found (3)

A

forearm extensors

over joints

pressure points

+/- lungs, sclerae, other tissues

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20
Q

describe RA nodules (2)

A

firm

not tender

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21
Q

what is this showing

A

RA vasculitis

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22
Q

ocular manifestations of RA

A

keratoconjunctivitis sicca

scleritis/episcleritis

scleromalacia

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23
Q

what do you think when you see RA and keratoconjunctivitis sicca, +/- xerostomia

A

secondary Sjorgen’s

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24
Q

mc pulmonary manifestation of RA

A

pleuritis

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25
Q

besides pleuritis, 3 other pulmonary manifestations of RA

A

pleural effusions

rheumatoid nodules

interstitial lung dz

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26
Q

cardiac manifestations of RA (3)

A

chronic inflammation → increased risk for CV dz

pericardial effusions

pericarditis

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27
Q

what does SANTA make you think of

A

RA → Felty syndrome

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28
Q

what does SANTA stand for

A

splenomegaly

anemia

neutropenia

thrombocytopenia

arthritis (RA)

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29
Q

in FELTY syndrome, neutropenia could be __

or the pt could have __

A

asymptomatic

frequent bacterial infxns

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30
Q

RA in FELTY syndrome is typically (3)

A

seropositive

erosive

severe

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31
Q

what % of RA pt’s are seronegative

A

15%

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32
Q

most specific bloodwork for RA

A

anti-CCP abs

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33
Q

seronegative RA involves a __ dx

A

clinical

34
Q

standard RF panel (5)

A

anti-CCP

RF

ESR/CRP

CCB

CMP

35
Q

do you need anti-CCP or RF for RA dx

A

no!

15% of pt’s are seronegative

36
Q

what might CBC show for RA (4)

A

mild anemia

thrombocytopenia

WBC normal

mild leukocytosis

37
Q

what do you think when you see: inflammatory effusion, leukocytosis, PMNs predominate

A

synovial fluid for RA

38
Q

in RA, leukocytes are typically between

A

15,00-25,000

39
Q

early imaging for RA will likely be

A

normal

40
Q

initial signs of radiographic damage w. RA

A

soft tissue swelling

osteopenia around joints

41
Q

earliest imaging e.o RA is seen in (2)

A

wrists

feet

42
Q

late imaging findings of RA (2)

A

joint space narrowing

erosions

43
Q

what categories does the American College of Rheumatology 2010 criteria include (4)

A

joint involvement

serology

acute phase reactants

duration of symptoms

44
Q

a score of __ in the American College of RA criteria is diagnostic for RA

A

6

45
Q

diagnostic criteria for RA (5)

A

inflammatory arthritis involving at least 3 joints

RF (+) AND/OR anti-CCP (+)

elevated ESR AND/OR CRP

duration of at least 6 weeks

excluded other causes

46
Q

3 tx goals for RA

A

control pain/inflammation

preserve fxn

prevent deformity

47
Q

what are DMARDs

A

disease modifying anti-rheumatic drugs

48
Q

mc combo pharm tx for RA

A

MTX (DMARD)

PLUS

TNF

49
Q

any pt on combo therapy needs

A

rheumatologist involvement

50
Q

screening considerations for RA

A

hep B & C

baseline labs

ophthalmic screening

latent TB

r.o pregnancy

baseline radiographs

51
Q

baseline labs for RA (5)

A

CBC

Cr

LFTs

ESR

CRP

52
Q

what pharm may be used for sx of RA, but should never be used as monotherapy

A

NSAIDs

corticosteroids

53
Q

tx for RA flare ups

A

steroids

54
Q

tx for recurrent RA flare ups

A

increase MTX

55
Q

what drug alleviates sx of RA AND slows rate of joint damage

A

corticosteroids

56
Q

how are corticosteroids used in RA

A

as a bridge to starting DMARDs

d.c as soon as possible

57
Q

starting bridging steroid and dose for

A

prednisone 5-20mg/day

58
Q

methotrexate

sulfasazaline

hydroxychloroquine

are all

A

DMARDs

59
Q

etanercept (Enbrel)

infliximab (Remicade)

Adalimumab

are all

A

biologics (TNF)

60
Q

suffix for most biologics

A

-mab

also cept

61
Q

mc DMARD

A

methotrexate

62
Q

starting dose for MTX

A

7.5 mg PO weekly

63
Q

pt should see improvement w. DMARD w.in

A

2-6 weeks

64
Q

contraindications for DMARDs (3)

A

pregnancy

liver dz

heavy etoh

severe renal impairment

65
Q

s.e of MTX (2)

A

GI upset

stomatitis

66
Q

monitoring labs for MTX

A

CBC → cytopenias

LFTs → hepatotoxicity

67
Q

all pt’s on MTX need to take

A

folic acid

OR

leucovorin calcium)

68
Q

folate prevents __

A

hematologic s.e

69
Q

TNF (biologics) inhibitors can be administered (2)

A

SQ

IV

70
Q

biggest barrier to TNF tx

A

expensive!

71
Q

major concern w. TNF inhibitors

A

higher risk for serious bacterial infxn

ex ganulomatous infxn

72
Q

mc granulomatous infxn associated w. TNF inhibitors

A

reactivation of TB

73
Q

screening test for all pt’s starting TNF inhibitor

A

latent TB

74
Q

t/f: TNF inhibitors have a lot of s.e

A

false!

few s.e, work very well, well tolerated

75
Q

1st choice for TNF inibitor

A

etanercept

76
Q

all pt on TNF inhibitor should be followed by

A

rheumatologist

77
Q

how do you monitor functional status of RA pt

A

pick a scale and stay consistent

78
Q

RA pt need f.u radiographs every

A

2 years

79
Q

highest cause of mortality in RA pt

A

CV dz from chronic inflammation

80
Q

poor prognostic factors for RA (4)

A

RF OR anti-CCP (+)

extraarticular dz

functional limitation

erosions on radiograph

clin med lab 2 - exam 1 (7 decks)

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