Rheumatoid Arthritis Flashcards
What is the pathology of RA?
Destruction of synovial joints w/ loss of cartilage & bone
Ligament/tendon damage
Loss of physical function, decreased quality of life
What are the 3 types of RA? Explain them.
Type 1 = self-limiting (5-20%)
Type 2 = minimally progressive (5-20%)
Type 3 = proressive (60-90%)
A 55 yo female presents complaining of joint pain in her hand. She has a ten-year pack history. On exam you squeeze her MCP & DIP joints are soft & squishy. They are also warm and slightly red, and it appears to be synovitis. What labs should you order?
RA Sed rate CRP Rheumatoid factor (sensitive) Anti-CCP (specific)
A 58 yo female with a 35 year pack history presents complaining of wrist pain. The joint is warm and squishy to touch. Based on her risk factors, what disease is most likely? What imaging should you order and what would you expect to see?
RA
X-Ray
Ulnar drift, symmetrical narrowing of wrist, MCP, & PIP
Mouse bite erosions
What is important to keep in mind when diagnosing RA?
It’s an “urgent diagnosis” because Tx can stop Dz progression
A 70 yo female with a family history of RA presents complaining of pain in her 4th and 5th MTP joints which are warm and slightly red. X-Ray shows symmetrical narrowing and mouse bite erosions. What treatment should you recommend (general)?
DMARDs NSAIDs TNF inhibitors B cells T cells I-6 JAK kinase inhibitors
A 59 yo female with a history of 20 pack years and a family history of RA presents with warm, soft, squishy TMJ joint. Her RA algorithm score is 7. What medicine should she absolutely be on?
DMARDs: Corticosteroids Hydroxychloroquine Sulfsalazine Methotrexate Leflunomide Azathioprine
A 63 yo female smoker presents with tenderness in her neck at the base of her skull. The joint is soft and squishy on palpation, and X-Ray shows symmetrical narrowing of the joint space. Sed rate and CRP are elevated, rheumatoid factor and anti-CCP are positive. After starting her on a DMARD, what other treatment could you recommend?
NSAIDs TNF inhibitors: Etanercept Infliximab Adalimumab Golimumab Certolizuma peogoles Bcell, Tcells, I-6, JAK, BRMs
When should you refer a pt with RA?
Uncertain Dx Confusing labs Uncomfortable with DMARD use Considering a biologic (TNF) Pt not responding Erosion/radiograph changes
A 6 yo presents with an intermittent high fever, transient rash, lymphadenopathy, hepatosplenomegaly, pleural effusion, and huge leukocytosis. What do you suspect? What complications are you worried about?
JRA
Still’s Dz
Iritis (if + ANA)
A 8 yo presents with monoarticular arthritis and uveitis. Her B27 genetic study comes back positive. What is your diagnosis? What treatment do you reocmmend?
Pauciarticular JRA PT/exercise Tylenol/NSAIDs (naproxen & ibuprofen) DMARDs!!! Corticoseroids Enbrel
A 7 yo presents with several warm, slightly red joints in her wrists as well as involvement of the neck and jaw. They are soft and squishy on palpation, and the pain is preventing her from participating in her soccer league and from walking up stairs. Labs show she is ANA +. What Tx should you recommend?
DMARDs (TNF inhibitors)
PT/exercise
Corticosteroids
Tylenol/NSAIDs (Naproxen & ibuprofen)
Enbrel
Refer to ophthalmology to watch for iritis b/c of her ANA + status
