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Musculoskeletal > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

If untreated, what are the results of RA?

A

Joint destruction
Deformity
Loss of function
Extra-articular complications

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2
Q

What gene predisposes to RA?

A

HLA-DR4

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3
Q

What environmental factors predispose to RA?

A

Viruses/bacterial infection

Smoking

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4
Q

What is the prevalence of RA in the population?

A

1%

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5
Q

Men are more likely to suffer from RA than women. T/F?

A

False- the opposite is true

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6
Q

In what ethnicities is RA more aggressive?

A

African American

Hispanic

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7
Q

What are the symptoms of RA?

A

Pain and stiffness which is persistent, symmetrical and affects the small joints more than the large joints

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8
Q

What are the signs of RA?

A

Synovitis
Deformities - swan neck, boutonniere, Z-thumb, ulnar deviation
Rheumatoid nodules

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9
Q

What are the differential diagnoses of RA?

A

Polyarticular gout
Psoriatic arthritis
Osteoarthritis
Systemic lupus erythematous

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10
Q

What investigations should be conducted in a patient with suspected RA?

A 
Non-specific laboratory conditions including CRP/ESR, EFB and bone/uraate profiles
Immunology lab invetsigations
Plain radiographs
Ultrasound
MRI
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11
Q

What is rheumatoid arthritis?

A

IgM antibody which is directed against the Fc portion of IgG antibodies

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12
Q

In what conditions is rheumatoid factor present?

A 
RA
SLE
Sjogren's
Hepatitis B and C
Bacterial endocarditis
Increasing age
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13
Q

Describe the role of CPP antibodies in RA?

A

Cause inflammation and cellular damage
Enzymatic process leads to the conversion of arginine residues to cirtrulline. The alteration of shapes creates a foreign antigen from self-anti citrullinated cyclic peptide antibodies.

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14
Q

What score is required in the EULAR classification criteria to diagnose RA?

A

6 or more

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15
Q

What factors are assessed in the EULAR classification criteria of RA?

A

Number of joints involved
Presence of RF or anti-citrullinated protein antibodies
Presence of acute phase proteins
Duration of symptoms

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16
Q

What are the first changes seen on X-Ray due to RA?

A

Peri-articular osteopeania

Soft tissue swelling

17
Q

What are the late changes seen on X-Ray due to RA?

A

Erosion
Joint destruction
Subluxation

18
Q

What are the aims of treatment in RA?

A

Reduce inflammation
Maintain joint function
Prevent progression

19
Q

What drugs can be used to to reduce inflammation in RA?

A

NSAIDs
COX-2 inhibitors (etoricoxib)
Steroids (oral, intramuscular or interarticular)

20
Q

What steroids can be given IM or intraarticularly in the treatment of RA?

A

Depomedrone

Kenalog

21
Q

Patients with RA should be offered classical disease modifying drugs within 3 months of symptom onset. T/F?

A

True

22
Q

Patients with RA should be offered classical disease modifying drugs within 3 months of symptom onset. Give examples of these drugs?

A

Methotrexate
Leflunomide
Sulfasalazine
Hydroxycholoroquinine

23
Q

What is the action of methotrexate?

A

Folate antagonist

24
Q

The use of methotrexate to treat RA requires monitoring of…?

A

LFTs

FBC

25
Q

Which classical disease modyfying drugs used in the treatment of RA are suitable for use in pregnancy?

A

Sulfaslazine

Hydroxychloroquinine

26
Q

What are the side effects of methotrexate?

A

GI effects

27
Q

What is the action of sulfasalazine in the treatment of RA?

A

Actions against folate, T and B cells

28
Q

The use of sulfasalazine to treat RA requires monitoring of…?

A

FBC
LFTs
U&Es

29
Q

What are the side effects of sulfasalazine?

A

GI effects
rash
headache

30
Q

What is the action of hydroxychloroquinine in the treatment of RA?

A

Blocks toll like receptors on PDCs

31
Q

What are the side effects of hydroxychloroquinine?

A

Headahce
Nausea
Muscle pain
Rash

32
Q

The use of hydroxychloroquinine to treat RA requires monitoring of…?

A

Occular monitoring every 5 years

33
Q

Screening for which diseases is required before initiation of biologic disease modifying anti-rheumatic drugs?

A

Hepatitis
HIV
Varicella
CXR

34
Q

What are the contraindications for the use of biologic disease modifying anti-rheumatic drugs?

A 
Active infection
Active or latent TB
Pregnancy
Malignancy
Diverticular disease

Musculoskeletal (11 decks)

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