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Clin Med IV Exam 1 > Rheumatoid Athritis > Flashcards

Rheumatoid Athritis Flashcards

1
Q

Pt population where rheumatoid arthritis is common seen in

A

Women (3x men) ages 40-50
Native Americans (5x higher)
Smokers (4x nonsmoker)

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2
Q

What area of the body does Rheumatoid Arthritis (RA) spares?

A

Lower back

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3
Q

Pathophysiology of RA

A
  • Genetic factor (HLA-DRB shared epitope)
  • Synovial membrane becomes hyperplastic –> immune and inflammatory cells –> synovitis
  • increase lvl of cytokines
  • APC, B cells, MHC, CD4+ T cells play a role
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4
Q

Does RA commonly affect 1 single joint or multiple joints?

A

Multiple joints

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5
Q

Which joints do RA commonly Affect?

A 
Small joints of hands (PIP joints), DIP spared
Feet
CERVICAL SPINE (not lower back)
Larger joints (shoulder and knees)
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6
Q

How does synovitis present?

A

Joints become swollen, tender, warm and stiff which causes limited movement

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7
Q

Are joints affected in a symmetrical or asymmetrical pattern?

A

Symmetrical

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8
Q

Where are rheumatoid nodules commonly located?

A

Bony prominences

  • olceranon
  • calcaneal tuberosity
  • MCP joints in hands
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9
Q

Which organs is usually not affected by RA?

A. Heart
B. Lung
C. Kidney
D. Eyes
E. Blood
A

C. KIDNEY

RA commonly affects:

  • Lungs–fibrous CT
  • Eyes–keratoconjunctivitis sicca
  • Skin–rheumatoid nodules
  • Heart–pericardial effusion
  • Nervous sytem–cervical spine instability (C1-C2)
  • Blood–hypochromatic microcytic anemia w/ low serum ferritin or normal ferritin
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10
Q

What are some cardiac complications caused by RA?

A 
MI
Disambiguation
Stroke
Atherosclerosis
Pericarditis
Endocarditis
LV HF
Vaculitis
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11
Q

What are some Physcial Exam findings of RA

A
  • warm tender erythematous joints (hand and wrist)
  • DIP excluded
  • Ulnar deviation of digits
  • Boutonniere’s deformity
  • Rheumatoid nodule
  • Baker cyst in popliteal space
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12
Q

What is the most specific lab finding that is suggestive of RA?

A

Anti-cyclic citrullinated peptide antibody (ACCPA)

-Rheumatoid factor can be falsely negative

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13
Q

What is the MAINSTAY tx of RA

A

METHOTREXATE (w/ or w/o biologic agent)

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14
Q

What else should a pt be on when initiated methotraxate for RA?

A

Corticosteroid (prednisone)

MTX +/-DMARD takes awhile to take effect

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15
Q

Will NSAIDs alter the disease progression of RA?

A

NO. only used for pain relief

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16
Q

What are DMARDs?

A

Dz modifying anti-rhuematoid drugs

17
Q

What is Felty’s Syndrome

A

RA + Neutropenia + Splenomegaly

18
Q

What cervical complication can be seen in RA?

A

Atlanto-axial subluxation

-caution cervical motion, avoid chiroparactors, can develop hand and foot paresthesia and paraplegia

19
Q

Does RA most commonly afffect the PIP or DIP joint?

A

PIP joint

SPARED DIP joint

20
Q

What does polymyalgia rheumatic (PMR) mainly affect?

A

Proximal muscles (upper arms, thighs, hip girdle and shoulders)

21
Q

Pathophys of PMR

A

idiopathic inflammatory disorder of pain mainly assoc w/ proximal muscles

Also assoc w/ temporal arteritis

22
Q

Presentation of PMR

A

-abrupt onset and self lmiting
-PAIN not weakness
-worse in AM
-general aches, pain and stiffness
“trouble getting dressed”

23
Q

What pt population is most common affected by PMR?

A

Elderly >50yo

24
Q

Tx of PMR

A

PREDNISONE

25
Q

How do you dx PMR

A

dx of exclusion

26
Q

Reactive arthritis aka…?

A

Reiter’s Syndrome

27
Q

What is the classic triad associated w/ reactive arthritis?

A

Urethritis
Arthritis
Conjunctivitis

Can’t see, can’t pee, can’t climb a tree

28
Q

Pathophys reactive arthritis

A

Autoimmune condition that occurs post infection (typically after GU or GI infection) and assoc w/ HLA-B27 haplotype

29
Q

Anterior uveitis is assoc with what other rheumatologic disorder?

A

Reactive arthritis

30
Q

Presentation of Anterior uveitis?

A
  • red eye
  • pain worsens when reading
  • progressive
  • blurred vision
  • photophobia
  • excess tear production
  • abnormally shaped pupils
31
Q

How would you tx reactive arthritis?

A

Symptomatic tx

2/3 will recover spontaneously

32
Q

What pt population does juvenile idiopathic arthritis affect?

A

Pt <16yo

commonly age 1-6

33
Q

Presentation of juvenile idiopathic arthritis?

A
  • Pain and swelling
  • 1st sx may be limping
  • fever and rash
  • lethargy, reduced activity, poor activity
  • all experience periods of sx reduce in severity or disappear but may go from sx free to extreme pain quickly
34
Q

Polymyositis presentation

A
  • proximal muscle WEAKNESS of upper and lower limbs, bilaterally
  • difficulty raising arms, lifting objects, combing hair
  • trouble climbing stairs
  • trouble lifting objects
35
Q

Dermatomyositis presentation

A 
Heliotrope rash (upper eyelids, cheek, upper trunk)
Grotton's papules (on knuckles)

*resemble mechanic hands

36
Q

Inclusion body myositis presentation

A
  • ASYMMETRICAL weakness
  • Quad weakness and atrophy
  • Facial muscle weakness (but not ocular)
  • Weakness and atrophy of distal muscles
  • Dysphagia and choking

*cannot tie knot or hold golf club

Clin Med IV Exam 1 (9 decks)

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