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Muscoskeletal > Rheumatoid Arthritis Day 1 > Flashcards

Rheumatoid Arthritis Day 1 Flashcards

1
Q

What is the epidemiology of RA?

A

Age onset :30-60
Women>men
Equal in racial groups
progressive

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2
Q

What are the theories that cause RA?

A 
Genetic Susceptibility with HLA-DR4 
Environment: 
-virus: Epstein Barr
-Bacteria: Strep, staph, e. coli
-chemical: silica, heavy metal, cigarette smoke
Hormones: estrogen
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3
Q

What is the pathophysiology of RA?

A

Chronic infmamattion of synovial tissue (Pannus)

This leads to cartilage and bone erosion

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4
Q

What antibodies are present in RA?

A

RF is positive and generally is >1:320

ACPA positive is poor prognosis

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5
Q

What Cell mediated functions are present in RA?

A

APC’s present self antigen to T lymphocytes and there are more T- helpers in synovial tissuse

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6
Q

What pro inflammatory cytokines are produces?

A

TNF- alpha, IL-1 and IL-6

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7
Q

What vasoactive substance are active in RA and what do they do?

A

Histamine and Prostoglandins. They increase blood flow to the site causing edema, warmth, erythmia and pain

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8
Q

What is the Disease course for RA?

A

It varies but most often it is a progressive onset with uninterupted symptoms resulting in disabling joint deformities. 1/3 of patients have mild intermittent symptoms followed by periods of remission. uncommon is sudden onset with a prolonged remission. Causes death if CV disease, cancer and infection

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9
Q

What is the clinical presentaiton of RA?

A 
joint muscle stiffness >6 weeks
fatigue, weakness, fever
morning stiffness that lasts hours
decreased appetite
joint pain with or without movement
symmetrical joint pain
increasing pain and stiffness
warmth and swelling over affected joints
Labs: RF, ACPA, ESR, CRP, CBC
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10
Q

What joints are involved in RA?

A

common- hands, wrist, feet

can be in elbows, shoulders, hips, knees and ankles

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11
Q

In RA, what is the articular manifestations in the hands?

A

Bilateral swelling of the MCP or PIP joints
Ulnar deviation of the fingers
swan neck/ boutonniere deformities

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12
Q

In RA, what is the articular manifestations in the shoulders?

A

limited Range of motion
tenderness
pain at night

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13
Q

In RA, what is the articular manifestations in the feet and ankles?

A 
flattening of the feet
hammer toes
halllus valgus (bunion)
calluses
pressure sores
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14
Q

In RA, what is the articular manifestations in the knees?

A 
loss of cartilage
instability and joint pain 
popliteal or Baker's cycts
muscle atropy
abdominal gail
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15
Q

In RA, what is the articular manifestations in the hips?

A

limited range of motion and very painful on movement

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16
Q

In RA, what is the articular manifestations in the spine?

A

typically affects the 1st and 2nd vertebrae
neck pain on movement
occipital headache
neurologic involvement

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17
Q

In RA, what is the involvement of Ocular?

A

inflammation of sclera, episclera, and cornea
decreased tear formation
sjogren’s syndrome

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18
Q

In RA, what is the involvement of Pulmonary?

A

plueral effusions and pulmonary fibrosis

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19
Q

In RA, what is the involvement of Cardiac?

A

increased cardiovascular mortality

pericarditis

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20
Q

In RA, what is the involvement of Rheumatoid nodules?

A

on in 20% and commin with erosive disease

asymptomatic

21
Q

In RA, what is the involvement of vasculitis?

A

in long standing RA and noticed around nail beds

22
Q

In RA, what is the involvement of Spleen?

A

Felty’s syndrome

23
Q

What are the Lab findings in RA?

A 
anemia of chronic disease
thrombocytopenia
elevated ESR
elevated CRP
RF and Titer
ACPA
ANA
synovial fluid analysis is turbid due to high # of leukocytes
Radiologic changes
24
Q

What is the Disease Prognosis of RA?

A

joint erosion within 2 years
damage seen in 4 months
decreased life expectancy by 5-7 years
20-50% go into remission

25
Q

What is a poor prognosis of RA?

A 
onset at earlier age
high titer of RF
increased ESR
swelling of >20 joints
presence of extraarticular manifestations
26
Q

How do you diagnose RA?

A

based on ACR/EULAR, you test patients who have atleast 1 joint with clinical synovitis with the synovitis not better explained by another disease. need a 6/10 points

27
Q

What are the points invloved with joints?

A

1 large joint - 0
2-10 large joints- 1
1-3 small joints (with or without large joints)- 2
4-10 small joints (with ot without large joints)- 3
>10 joints (at least 1 small)- 4

28
Q

What are the points involved in serology?

A

Negative RF and ACPA- 0
Low + RF or ACPA- 1
high + RF ot ACPA- 2

29
Q

What are the points involved in acute phase reactant?

A

normal ESR and and CRP-0

abnormal ESR or CRP-1

30
Q

What is the points possible for the duration of symptoms?

A

6 weeks- 1

31
Q

What are the goals of therapy?

A 
remission
improve/maintain functional status
maximize QOL
control joint pain
slow rate of joint damage
32
Q

What is the criteria for Remission?

A

need 5 or greater for more than 2 months:
morning stiffness no more than 15 min
no joint tenderness or pain with movement
ESR <30 for women
no fatigue
no joint pain

33
Q

What are your non pharmacologic therapy for RA?

A 
Patient education 
Rest
OT and PT
Wt reduction
Surgery
34
Q

What are the 4 classes of pharmacotherapy for RA?

A

NSAIDs
Corticosteroids
DMARDs
Biologic DMARDs

35
Q

NSAIDS MOA?

A

inhibits COX 1 and 2 and inhibits prostoglandin syntheisis

36
Q

NSAIDs monitoring?

A

SCr, BUN, CBC

37
Q

NSAIDs dosing?

A

IBU: 1200- 3200mg/day in 4-6 divided doses
Naproxen: 250-1500 mg/day in 2 divided doses
Nabumentone: 500-2000 mg/day in 1-2 divided doses

38
Q

NSAIDs adverse effects?

A

GI bleeding and renal damage

39
Q

NSAIDs place in therapy?

A

analgesit and antiinflammatory properties. Antiinflammatory is for symptom control. Not to be given as mono therapy. can be schedules or PRN

40
Q

what effects does Corticosteroid have?

A

anti-inflammatory and immunosuppressive

41
Q

What is Bridge Therapy use for corticosteroids?

A

use in patients with deliberating symptoms when DMARD is initiated

42
Q

What is continuous low dose therapy use for corticosteroids?

A

dificult to control in patients and is no more than 7.5 mg/day

43
Q

What is short term high dose use for corticosteroids?

A

suppress disease flares and is 60 mg/day

44
Q

What are the intra-muscular injections for in corticosteroids?

A

for non complient patients. it is like low dose therapy. Gives 2-8 weeks of relief. Is a physiological tamper

45
Q

What are the IV injections for in corticosteroids?

A

only severe symptoms

46
Q

What are the intra-articular injections for in corticosteroids?

A

treats synovitis and pain. can be repeated every 3 months

47
Q

What are the adverse effects of corticosteroids?

A

HTN, hyperglycemiam osteoporosis

48
Q

What do you need to monitor in corticosteroids?

A

BP, Glucose, BMD

49
Q

What is the adjective treatment with corticosteroids?

A

Calcium 1500mg/d and Vit D 400-800 IU/day. Bisphosphonate if needed

Muscoskeletal (9 decks)

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