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NURP 503 Exam 2' > rheumatoid arthritis > Flashcards

rheumatoid arthritis Flashcards

1
Q

The peak incidence of rheumatoid arthritis is between the _______ and _________decades of life?

A

Fourth and Fifth

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2
Q

Is Rheumatoid arthritis more common in males or females?

A

2.5 times more common in females

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3
Q

How many weeks of symptoms have to be present before a diagnosis of rheumatoid arthritis can be made?

A

6 weeks

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4
Q

Does RA include morning stiffness, fatigue and gradual improvement of stiffness as day goes on?

A

Yes

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5
Q

Is RA symmetrical and polyarticular (affecting more than one joint)?

A

Yes

have inflammatory synovitis (palpable/touchable synovial fluid)

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6
Q

What joints does RA usually affect?

A

wrists
MCP
PIP joints

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7
Q

What joints does RA NOT affect?

A

DIPs of the fingers
thoracolumbar spine
IPs of the toes

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8
Q

What do the nodules with RA typically look like?

A

subcutaneous or periosteal at pressure points (along where people lie on their arms)

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9
Q

What percentage of people will be positive for the rheumatoid factor serological test at 6 months? at 2 years?

A

50% at 6 months

85 % at 2 years

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10
Q

T/F a low titer for RF is not specific but a high titer early is a bad sign?

A

TRUE

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11
Q

What four serological markers are used for diagnosis of RA?

A

RF (rheumatoid factor)
Anti-CCP (Anti-cyclic citrullinated peptide antibody)
Sed rate (ESR)
CRP

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12
Q

If RF and Anti-CCP are positive there is a higher correlation with _____________ disease?

A

erosive

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13
Q

Marginal spacing and joint space narrowing on X-ray are also a ______________ sign of RA?

A

positive

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14
Q

With the new RA diagnosing criteria, how many points are needed for a diagnosis of RA?

A

6 out of 10 points

  • *must have at least one joint with definite clinical synovitis
  • ** the synovitis present can’t be explained by another disease condition
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15
Q

How many points do you get for joint swelling in 4-10 small joints?

A

3 points

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16
Q

How many points do you get for joint involvement in 2-10 large joints?

A

1 point

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17
Q

How many points do you get for joint involvement in 1 large joint?

A

0 points

Typically RA is not associated with large joints

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18
Q

How many points do you get for joint involvement in 1-3 small joints?

A

2 points

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19
Q

How many points do you get for joint involvement greater than 10 joints with at least one small joint?

A

5 points

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20
Q

How many points for next following questions:

Negative RF and negative anti-CCP?

A

0 points

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21
Q

duration of symptoms over 6 weeks

A

1 point

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22
Q

High positive RF and High positive anti-CCP

A

3 points

23
Q

Low positive RF OR low positive anti-CCP

A

1 point

24
Q

Normal CRP and normal ESR?

A

0 point

25
Q

Abnormal CRP OR abnormal ESR?

A

1 point

26
Q

What is the major cell type in synovial fluid?

A

Neutrophils

27
Q

Synovial fluid in RA is over or under produced?

A

Overproduced

28
Q

What is it called when synovial fluid becomes old and thickened?

A

Pannus

29
Q

What are the major cell types of Pannus?

A

T-Lymphocytes

Macrophages

30
Q

What type of hemorrhages can be seen with RA in the fingers and nail beds?

A

Splinter Hemorrhages

31
Q

What are some systemic conditions patients can have with RA?

A 
fatigue
Raynauds phenomenon
pleuritis or pericarditis
vascularitis
interstitial lung disease
dry eyes and mouth
32
Q

What do you do with patient once diagnosis of rheumatoid arthritis has been made?

A

refer them to rheumatology for mangement

33
Q

How often do you need to monitor the patient for adverse effects of the medications?

A

At least every 2 months

34
Q

Are NSAIDs used for RA patients and do they prevent disease progression

A

Yes NSAIDS are used for symptomatic relief and improved function
they DONT change disease progression

35
Q

What consideration must be taken into account with prolonged prednisone use in patient?

A

Consider prophylactic osteoporosis medication

36
Q

T/F Intraarticular steroid injections can be used for specific joints treatments?

A

TRUE

37
Q

What are some DMARDs used for RA?

A

plaquenil (hydroxychloroquine)
sulfasalazaline
methotrexate (highly effective single DMARD)
leflunomide
azathioprine
cyclophosphamide
cyclosporine
They only have a moderate effect but they are low cost
DMARDs= disease modifying anti rheumatic drugs

38
Q

Which medication is the GOLD standard drug for treatment of RA?

A

Methotrexate

39
Q

Methotrexate can cause ________ and __________ suppression.

A

Hepatotoxicity

Bone marrow

40
Q

What labs need to be checked when patient is taking methotrexate and how often?

A

Liver function tests need to be checked every 8 weeks after established but initially every 2-3 weeks with beginning medication
Once patient goes a year without elevated liver enzymes patients can come in every 12 weeks.
patients need to be seen 3-6x/year for monitoring.

41
Q

What two diseases are contraindicated for the use of methotrexate and why>

A

Type 2 Diabetes mellitus
Obesity
**due to increased risk of hepatic fibrosis

42
Q

T/F patients taking methotrexate are at increased risk of developing lymphoma?

A

TRUE (autoimmune disease increases risk with or without medication)

43
Q

What drugs are the TNF inhibitor biologics used for RA?

A 
tumor necrosis factor inhibitors
Remicade (given IV in office)
Embrel
Humira
Cimzia (newer biologic)
Simpomi 
Cimzia and Simpomi are given 1x/month SQ
44
Q

Tumor necrosis factor is present in the ________. It causes __________, ______________ and __________.

A 
present in the synovial fluid
TNF causes:
bone erosion
pain/joint swelling (synovitis)
joint space narrowing (cartilage degradation)
45
Q

When the B cell is activated what does it cause to happen?

A

B cell activation produces the release of the anti necrosis factor, IL-1 and IL-6 which leads to inflammation and destruction of the joint.

46
Q

Before initiating the TNF inhibitors need to use which drugs first?

A

Plaquenil
Sulfasalazine
azathioprine
*** in combination with methotrexate

47
Q

When would you switch the patient to TNF inhibitors?

A

When bone erosion starts to occur in patient.

48
Q

Which key feature is NOT included in the diagnosis of rheumatoid arthritis?
A. symptoms lasting longer than 6 weeks
B. morning stiffness
C. thoracolumbar spine pain
D. symmetrical pain and swelling in the hands

A

C. thoracolumbar spine pain NOT feature of RA

49
Q 
What diagnostic test would you want to order to confirm suspicion of diagnosis of RA?
A. rheumatoid factor RF
B. anti-CCP
C. x-ray of the hands
D. all of the above
A

D. All of the above.

50
Q

Why is early diagnosis essential? Please choose the best statement.

A. The more involved the pain and swelling at baseline, the worse the future will be for the patient.

B. Early intervention can make a difference in long-term progression of the disease.

C. Seropositive disease is more aggressive, causing erosions and structural damage to the bone.

D. All of the above

A

D. all of the above.

51
Q 
What other systems can RA affect besides the joints? 
A. Cardiac system
B. Pulmonary system
C. Vascular system
D. All of the above
A

D. All of the above.

52
Q 
What is the first-line treatment of RA? 
A. Methotrexate
B. TNF
C. Inhibitors
D. Cyclophosphamide
E. Actemra
A

A. methotrexate

53
Q

According to the BeSt trial

A. Monotherapy is the best way to start treatment

B. Combination therapy provides earlier clinical improvement and less progression of joint damage after a year compared to initial monotherapies

C. Monotherapy is just as effective as combination treatment in rapidly eliminating clinical symptoms

A

B. Combination therapy provides earlier clinical improvement and less progression of joint damage after a year compared to initial monotherapies

54
Q

According to the New England Journal of Medicine paper, triple therapy with MTX, sulfasalazine, and Plaquenil is noninferior to treatment with Enbrel and methotrexate. Is this true, and if so, why is this important?

A

Triple therapy is more cost effective then combination therapy with MTX and Enbrel. The TNF medications are biologics, and they are very costly ($30,000 to $40,000 per year). Use of TNF inhibitors should be used after failure of triple therapy for that reason. But of course if there are side effects, we would move in that direction sooner rather then later.

NURP 503 Exam 2' (23 decks)

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