Rheumatoid Arthritis - Knowles

Question 1

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

Answer 1

passive and active ROM pain; extremity held in slight flexion

Question 2

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

Answer 2

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

Question 3

What are the likely causes of monoarthritis?

Answer 3

septic, crystal induced, hemarthrosis, OA, malignancy

Question 4

what are the likely causes of oligoarthritis?

Answer 4

OA, spondyloarthritis, early RA/SLE, crystal induced

Question 5

What are the likely causes of polyarthritis?

Answer 5

OA, RA, SLE

Question 6

migratory arthralgias suggest what infections?

Answer 6

rheumatic fever, Neisserial infx, lyme disease

Question 7

What labs would you run on a patient with RA?

Answer 7

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

Question 8

What other diseases may have a positive rheumatoid factor?

Answer 8

Hep C, endocarditis, Sjogren’s

Question 9

What are the contraindications for arthrocentesis?

Answer 9

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

Question 10

What are some MSK imaging findings in RA?

Answer 10

periarticular osteopenia
erosions
chondrocalcinosis

Question 11

Pts with RA have increased risk for what disease?

Answer 11

CVD

Question 12

What is the peak age and gender for RA?

Answer 12

40-60 females

Question 13

What risk factor increases the chance of having rA?

Answer 13

smoking

Question 14

What are the extra-articular manifestations of RA?

Answer 14

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

Question 15

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

Answer 15

nodules

Question 16

What appearance do the lungs have in RA?

Answer 16

ground glass

Question 17

How should you use steroids in rA?

Answer 17

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

Question 18

What is the MOA of methotrexate?

Answer 18

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

Question 19

What method of admin is most useful for MTX?

Answer 19

subQ

Question 20

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

Answer 20

hep B and C

Question 21

MTX is (teratogenic/carcinogenic)

Answer 21

teratogenic

Question 22

What cannot you not do if you are taking MTX?

Answer 22

drink

Question 23

What are the side effects of MTX?

Answer 23

hair loss, oral ulcers, nausea malaise

Question 24

What is a rare serious complication of MTX?

Answer 24

pneumonitis

Question 25

What is the MOA of leflunomide?

Answer 25

Pyrimidine synthesis inhibitor / dihydroorotate dehydrogenase

Question 26

Which DMARD is okay to use in renal insufficiency?

Answer 26

Leflunomide

Question 27

What are the side effects of leflunomide?

Answer 27

HA, diarrhea, cytopenias, abnl LFTs

Question 28

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

Answer 28

usually reserved for combination therapy or patients that cannot take methotrexate

Question 29

What are the side effects of sulfasalazine?

Answer 29

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

Question 30

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

Answer 30

hemolytic anemia

Question 31

What is the least potent but best tolerated DMARD?

Answer 31

hydroxychloroquine

Question 32

infliximab and golimumab are anti (TNF/IL6) agents

Answer 32

anti TNF

Question 33

How are infliximab and golimumab given?

Answer 33

IV

Question 34

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

Answer 34

subQ

Question 35

tocilizumab is an anti (blank) DMARD

Answer 35

anti IL5

Question 36

What are the side effects of tocilizumab?

Answer 36

Cytopenias, LFTs, lipids, diverticulitis

Question 37

Orencia/abatacept is an anti(blank) DMARD

Answer 37

CTLA4

Question 38

Orencia should be avoided in pts with (blank)

Answer 38

COPD

Question 39

What is the anit CD20 DMARD?

Answer 39

rituximab

Question 40

What is the serious side effect of rituximab?

Answer 40

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

Question 41

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

Answer 41

Tofacitinib/Xeljanz

Question 42

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

Answer 42

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

Question 43

SHould you do mono or comob therapy for RA?

Answer 43

mono therapy

Question 44

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

Answer 44

NEVER do that

Question 45

How often should you change an RA dose?

Answer 45

every three months

Question 46

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

Answer 46

anti drug Ab

Question 47

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

Answer 47

folate