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724: Medical Lectures > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

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USMLE® Step 1 flashcards
1
Q

Rheumatoid arthritis is an autoimmune disorder whose main manifestation is in what types of joints?

A

multiple synovitis joints

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2
Q

Is RA more common in men or women?

A

women

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3
Q

What are the pathologic findings in a RA joint?

A

Chronic synovitis with the formation of a pannus

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4
Q

What is a pannus?

A

It is abnormal granulation tissue that erodes cartilage, bone, ligaments, and tendons

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5
Q

What are the characteristics of acute phase RA?

A

Effusion and warmth

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6
Q

What are the characteristics of late phase RA?

A

Fibrous ankylosis

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7
Q

RA has an _____ onset with vague periarticular pain or stiffness.

A

insidious

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8
Q

Stiffness associated with RA persists for at least __ minutes in the morning

A

30

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9
Q

What joints does RA typically affect?

A
  • PIP joints of the fingers
  • MCP joints
  • wrists
  • knees
  • ankles
  • MTP joints
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10
Q

What may also occur with RA?

A

Synovial cysts and rupture of tendons

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11
Q

Does RA affect the spine?

A

It can affect the neck, but spares the remainder of the spine. In advanced RA patients AA subluxation is possible, which leads to death (Important to keep in mind during surgery).

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12
Q

__% of patients have RA nodules

A

20

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13
Q

Where do RA nodules predominate?

A
  • Bony prominences
  • Bursae
  • Tendon sheaths
  • Lungs
  • Sclerae
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14
Q

What type of ocular symptoms are seen in patients with advanced RA?

A
  • Dryness of eyes, mouth and other mucous membranes
  • Episcleritis
  • Scleritis
  • Scleromalacia
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15
Q

What are other symptoms associated with RA?

A
  • Interstitial lung disease
  • Pericarditis and pleural disease
  • Small vessel vasculitis
  • Necrotizing arteritis
  • Felty syndrome
  • Aortitis
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16
Q

Anti-CCP antibodies and Rheumatoid factor are present in __-__% of patients with established RA

A

70-80

17
Q

Which lab finding is the most specific blood test for RA?

A

Anti-CCP antibodies

18
Q

What percentage of RA patients have antinuclear antibodies (ANA)?

A

20%

19
Q

When is an arthrocentesis required?

A

When a patient with RA has one joint inflamed out of proportion to the rest in order to detect septic arthritis

20
Q

Of all laboratory tests, which is the most specific to RA?

A

imaging

21
Q

What are some differential diagnoses of RA?

A
  • Osteoarthritis
  • CPPD arthritis
  • Gouty arthritis
  • Spondyloarthropathies
  • Chronic Lyme disease
  • Human parvovirus B 19 infection
  • Hepatitis C
  • SLE
  • Polymyalgia rheumatica
  • Rheumatic fever
  • Cancers
22
Q

What are the 3 objectives to treating RA?

A
  • reduction of inflammation and pain
  • preservation of function
  • prevention of deformity
23
Q

What type of pharmacologic intervention should be started ASAP?

A

Disease-modifying antirheumatic drugs (DMARDs)

24
Q

What are often used as a “bridge” to reduce disease activity until the slower acting DMARDs take effect?

A

corticosteroids

25
Q

What are the 6 types of synthetic DMARDs?

A
  • Methotrexate
  • Sulfasalazine
  • Leflunomide
  • Antimalarials
  • Minocyline
  • Tofacitinib
26
Q

What are the 4 types of biologic DMARDs?

A
  • Tumor Necrosis Factor Inhibitors
  • Abatacept
  • Rituximab
  • Tocilizumab
27
Q

As a general rule, DMARDs have greater efficacy when administered how?

A

in combination rather than when used individually

28
Q

What is the most commonly used combination of DMARDs to treat RA?

A

methotrexate with one of the TNF inhibitors

29
Q

What are the 5 most common deformities that occur in patients with RA?

A
  • ulnar deviation of the fingers
  • boutonnière deformity
  • “swan-neck” deformity
  • valgus deformity of the knee
  • volar subluxation of the MTP joints
30
Q

The excess mortality associated with rheumatoid arthritis is largely due to what?

A

cardiovascular disease that appears to be a result of deleterious effects of chronic systemic inflammation on the vascular system

31
Q

What is essential for appropriate diagnosis and the timely introduction of effective therapy?

A

Early referral to a rheumatologist

724: Medical Lectures (42 decks)

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