Rheumatoid arthritis

Question 1

Sxs of RA?

Answer 1

early-morning stiffness lasting for >1 hour
symptoms for >6 weeks
swelling in five or more joints
symmetry of the joints involved

Question 2

Labs and XR findings in RA?

Answer 2

RF or anti CCP Ab positive
elevated inflammatory markers with one or more of the above
plain radiographs demonstrating erosive changes at the marginal zones of affected joints and juxta-articular osteopenia

Question 3

Risk factors for RA?

Answer 3

female
fam hx of RA
hx smoking
genetic susceptibility (HLA DR4)
\+ anti–CCP antibody or RF

Question 4

Txt of RA?

Answer 4

Methotrexate, up to a usual maximal dose of 25 mg weekly, is considered an “anchor” drug to which other DMARDs are added
watch for infxn or reactivation of HSV/Mycobacterium tuberculosis
NSAIDs and Tylenol to manage pain
consider adding low dose prednisone when starting DMARD or during flares
Can add TNF inhibitor to glucocorticoid + MTX or non TNF biolgic

Question 5

Extra-articular sxs of RA?

Answer 5

ILD, sicca, episcleritis, or scleritis 
splenomegaly with neutropenia (Felty syndrome)
secondary CKD (due to amyloidosis)
vasculitis
rheumatoid nodules

Question 6

If placed on etanercept + MTX for RA, received remission, better to taper off etanercept or keep at lowest dose?

Answer 6

Better control with reduced dose etanercept + MTX

Question 7

Efficacy of MTX, suflasalazine and hydroxychloroquine combinations for RA?

Answer 7

Triple combination is better than either with MTX alone