Rheumatoid Arthritis

Question 1

What is RA

Answer 1

chronic inflammatory autoimmune disorder
most common systemic inflammatory disease
symmetrical joint involvement

Question 2

What extra-articular components of the body are commonly involved in RA

Answer 2

Rheumatoid nodules
vasculitis
eye inflammation
neurologic dysfunction
cardiopulmonary disease
lymphadenopathy
splenomegaly

Question 3

What is the pathophysiology of RA

Answer 3

chronic inflammation of synovial tissue

• -> pannus
• -> erosions of bone/cartilage
• -> destruction of joint

Question 4

What is pannus

Answer 4

inflamed, proliferating synovium

Question 5

How long is the course for RA

Answer 5

slow, gradual over weeks to months

Question 6

What is the prodrome for RA

Answer 6

fatigue
weakness
low-grade fever
loss of appetite
joint pain

Question 7

What is usually involved with RA

Answer 7

small joints of hands, wrists and feet

symmetrical

Question 8

What are potential outcomes of RA even with txt

Answer 8

progressive joint destruction
deformity
disability
premature death

Question 9

How is RA classified

Answer 9

Class 1 - no affect
Class 2 - affect avocational
Class 3 - affect vocational and avocational
Class 4 - limited ability to perform self-care

Question 10

What are txt goals for RA

Answer 10

reduce/eliminate pain
protect articular surfaces
control systemic complications
prevent loss of joint function
improve or maintain QOL

Question 11

What are non-pharm txt for RA

Answer 11

Rest
OT
PT
patient education
assistive devices
weight reduction
surgery
support groups

Question 12

What are pharm txt for RA

Answer 12

Treat early and aggressively

start DMARDs within 3 months of diagnosis

Question 13

What meds are used to txt RA

Answer 13

NSAIDs
glucocorticoids
nonbiologic DMARDs
biologic DMARDs

Question 14

What factors affect txt decisions for RA

Answer 14

disease activity
disease duration
Prognosis

Question 15

What are signs of poor prognosis with RA

Answer 15

functional limitation
extra-articular disease
\+Rh factor
anticyclic citrullinated peptide antibodies
bony erosions

Question 16

What is important to know about NSAIDs with RA

Answer 16

full anti-inflammatory doses
don’t prevent dx progression
“bridge therapy” role
patient with RA 2x likely for serious complications than patient with OA

Question 17

What are alternatives to nonselective NSAIDs with RA

Answer 17

nonacetylated salicylate
COX-2 inhibitor
NSAID + gastroprotective agent

Question 18

What is important to know about corticosteroids with RA

Answer 18

avoid if possible
anti-inflammatory and immunosuppressive effects
short-term high-dose bursts to control flares
bridging therapy

Question 19

What are AE for corticosteroids with RA

Answer 19

HTN
hyperglycemia
cataracts
skin fragility
fluid retention
weight gain
osteoporosis

Question 20

What are concerns with corticosteroids and osteoporosis

Answer 20

increase risk of osteoporosis
Prevent with 1500 mg Ca per day
Prevent with 400-800 IU of vitamin D per day

Question 21

What are alternatives to corticosteroids with osteoporosis

Answer 21

raloxifene

bisphosphonates

Question 22

What are nonbiologic DMARDs for RA

Answer 22

Methotrexate
Leflunomide
Minocycline
Hydroxychloroquine
sulfasalazine

Question 23

What should be initial DMARD therapy for active or severe RA

Answer 23

methotrexate

Question 24

What is the alternative if methotrexate not work

Answer 24

leflunomide

Question 25

What is initial DMARD therapy for active or milder RA

Answer 25

hydroxychloroquine

Question 26

What do biologic DMARDs inhibit

Answer 26

tumor necrosis factor-alpha
interleukin-1
peripheral beta cells
T-cell activation
interleukin-6