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Block 7 Week 5 Colt > Rheumatoid Arthritis - Knowles > Flashcards

Rheumatoid Arthritis - Knowles Flashcards

1
Q

How do you know if pain is coming from the joint itself?

A

passive and active ROM pain; extremity held in slight flexion

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2
Q

What are the words used to describe the number of joints involved in rA?

A

Monoarticular: 1 joint
Oligoarticular: 2-4 joints
Polyarticular: 5 or more joints

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3
Q

What are the likely causes of monoarthritis?

A

septic, crystal induced, hemarthrosis, OA, malignancy

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4
Q

what are the likely causes of oligoarthritis?

A

OA, spondyloarthritis, early RA/SLE, crystal induced

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5
Q

What are the likely causes of polyarthritis?

A

OA, RA, SLE

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6
Q

migratory arthralgias suggest what infections?

A

rheumatic fever, Neisserial infx, lyme disease

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7
Q

What labs would you run on a patient with RA?

A 
Acute phase reactants
CBC – anemia, thrombocytosis
CMP – renal, hepatic involvement
Serologies – ANA, RF, CCP
Thyroid function 
Hepatitis panel or other infectious studies
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8
Q

What other diseases may have a positive rheumatoid factor?

A

Hep C, endocarditis, Sjogren’s

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9
Q

What are the contraindications for arthrocentesis?

A

Prosthetic joint
Overlying cellulitis, septic bursitis
Disrupted skin barrier
Bleeding disorder or anticoagulation (relative)

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10
Q

What are some MSK imaging findings in RA?

A

periarticular osteopenia
erosions
chondrocalcinosis

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11
Q

Pts with RA have increased risk for what disease?

A

CVD

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12
Q

What is the peak age and gender for RA?

A

40-60 females

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13
Q

What risk factor increases the chance of having rA?

A

smoking

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14
Q

What are the extra-articular manifestations of RA?

A 
Episcleritis, scleritis, sicca
Nodules
Interstitial lung disease, pulmonary nodules
Pericarditis
Vasculitis
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15
Q

granulomatous reaction, pallisading macrophages, center fibrinoid necrosis are characteristics of (blank) associated with rA

A

nodules

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16
Q

What appearance do the lungs have in RA?

A

ground glass

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17
Q

How should you use steroids in rA?

A

reserve for flares, have lots of side effects: Weight gain, insomnia, cataracts, hypertension, hyperlipidemia, diabetes, osteoporosis, psychiatric disturbances

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18
Q

What is the MOA of methotrexate?

A

Inhibits dihydrofolate reductase, affecting purine synthesis/DNA/RNA/protein synthesis

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19
Q

What method of admin is most useful for MTX?

A

subQ

20
Q

What types of infections do you need to screen for before starting someone on MTX?

A

hep B and C

21
Q

MTX is (teratogenic/carcinogenic)

A

teratogenic

22
Q

What cannot you not do if you are taking MTX?

A

drink

23
Q

What are the side effects of MTX?

A

hair loss, oral ulcers, nausea malaise

24
Q

What is a rare serious complication of MTX?

A

pneumonitis

25
Q

What is the MOA of leflunomide?

A

Pyrimidine synthesis inhibitor / dihydroorotate dehydrogenase

26
Q

Which DMARD is okay to use in renal insufficiency?

A

Leflunomide

27
Q

What are the side effects of leflunomide?

A

HA, diarrhea, cytopenias, abnl LFTs

28
Q

Sulfasalazine is reserved for pts that can’t handle what drug?

A

usually reserved for combination therapy or patients that cannot take methotrexate

29
Q

What are the side effects of sulfasalazine?

A

GI side effects
Hypospermia/infertility
Cytopenias, agranulocytosis, hemolytic anemia/G6PD deficiency

30
Q

What happens if you take sulfasalazine if you have G6PD def?

A

hemolytic anemia

31
Q

What is the least potent but best tolerated DMARD?

A

hydroxychloroquine

32
Q

infliximab and golimumab are anti (TNF/IL6) agents

A

anti TNF

33
Q

How are infliximab and golimumab given?

A

IV

34
Q 
How are the following anti-TNF drugs given?
Enbrel/etanercept (weekly)
Humira/adalimumab (q2 wk)
Simponi/golimumab  (monthly)
Cimzia/certolizumab pegol (q2 or4 wk)
A

subQ

35
Q

tocilizumab is an anti (blank) DMARD

A

anti IL5

36
Q

What are the side effects of tocilizumab?

A

Cytopenias, LFTs, lipids, diverticulitis

37
Q

Orencia/abatacept is an anti(blank) DMARD

A

CTLA4

38
Q

Orencia should be avoided in pts with (blank)

A

COPD

39
Q

What is the anit CD20 DMARD?

A

rituximab

40
Q

What is the serious side effect of rituximab?

A

Progressive multifocal leukoencephalopathy; can’t give vaccines because B cells are down regulated

41
Q

What is the newest biologic DMARD that targets the JAK3 pathway?

A

Tofacitinib/Xeljanz

42
Q

What are some of the general risks associated with biologic DMARDS?

A

Risk of infections, some life threatening
Reactivation TB
Endemic fungal infections
Screening: hep B/C, PPD, CXR + possible fungal serologies

43
Q

SHould you do mono or comob therapy for RA?

A

mono therapy

44
Q

T/F: you should do combo biologic DMARD therapy if possible

A

NEVER do that

45
Q

How often should you change an RA dose?

A

every three months

46
Q

DMARD with a biologic prevents the formation of anti-(blank) Ab formation

A

anti drug Ab

47
Q

what do you give in combo with MTX to help prevent side effects?

A

folate

Block 7 Week 5 Colt (7 decks)

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