Saad - Rheumatoid Arthritis Flashcards
true or false
rheumatoid arthritis is a systemic disorder
true
which is more debilitating and concerning and why- osteoarthritis or rheumatoid arthritis?
rheumatoid arthritis
it is potentially deforming and more systemic than osteo – can affect other organs
EXTRA-ARTICULAR INVOLVEMENT
true or false
RA is not an inflammatory disorder
false - it is
what is polyarthritis
potentially can affect RA patients — 5 or more joints have RA
does RA ever affect children?
yes, under 16 it’s called juvenile RA
true or false
pts with RA have increased incidence in premature death
true
which gender is more prone to developing RA
female
name 3 ways in which the course of RA can differ from patient to patient and explain each
polycyclic
monocyclic
progressive
polycyclic - symptoms come and go repeatedly
monocyclic - comes, goes, and never comes back (rare)
progressive - keeps getting worse every cycle
name 4 general causes of RA
genetic
environmental
effects of advancing age
changes in muscskel and immune system
which is characteristic of having LESS signs of inflammation - OA or RA
OA
RA has lot of heat swelling stiffness - doesnt HAVE to be pain
name 4 joints most commonly affected by RA
hands
wrists
ankles
feet
(smaller joints)
RA is often uni or bi lateral?
bi
prolonged morning stiffness - longer than 30 mins - RA or OA?
RA
in which chronic arthritis do patients usually have better functionality
osteo
in RA, symptoms are present for _ weeks or more
6 weeks
what is subluxation
partial dislocation of a joint
____ and ____ are possible with advanced RA disease
subluxations and deformities
what are general, nonspecific implications of RA
generalized fatigue, weakness, and decreased mood
how can RA have extra-articular involvement involving the lungs
name 2 things
rheumatoid nodule formation on extensor or pleural lining
interstitial lung disease or pleural disease
can RA affect the CV system?
yes
vasculitis
myocarditis
pericarditis
abnormal cardiac conduction
name 2 ways RA can affect blood cell count
anemia
felty’s syndrome (swollen spleen, dec WBC)
can RA affect the eyes?
yes
in radiography OA vs RA, explain how you can differentiate the 2
the presence of SYNOVIAL SOFT TISSUE (membrane) SWELLING indicates clearly it is RA. also, late stage, may show subluxations, deviations, and secondary arthritis
both will have narrowing of joints
true or false
there is no single diagnostic lab test for RA
TRUE
as mentioned, there is no single RA diagnostic test
name 5 that may be used to indicate RA (but not definitively)
RF factor - if have, disease usually more progressive
CRP (c reactive protein) - result of inflammation
high ESR (result of inflammation)
anti citrullinated peptide antibody - more specific to RA - usually more aggressive if this is here
synovial fluid analysis - LOT OF WBC
true or false
erythrocyte sedimentation rate (ESR) is elevated in RA patients and normal in OA patients
TRUE – due to presence of inflammation in RA patients
which diagnostic test is most specific to RA and what is it testing for?
can it be used to diagnose RA
no
lookinf for an anticyclic citrullinated peptide antibody - most specifically mutated citrullinated vimentin
true or false
lab tests alone are used to diagnose RA
false - multi factors
clinical presentation + lab results
synovial fluid analysis of an RA patient will reveal what?
high WBC when there’s no crystals or infection
true or false
joint replacement of a joint affected by RA will get rid of the arthritis in the joint
FALE – this is true for OA
RA is autoimmune – it will just attack
if remission of RA cannot be achieved, what is the goal according to ACR and EULAR
treat to target approach — LOW DISEASE ACTIVITY
to improve function and QOL, control activity of disease and pain, SLOW PROGRESSION, reduce deformities, improve extra-articular manifestations
why does RA treatment involved shared clinical decision making between pts and HCP
the medications have a lot of side effects
treatment in RA should involve measuring _____ and adjust ______ as appropriate
measuring disease activity and adjust therapy as appropriate
true or false
active exercising is a nonpharmacologic treatment for RA
FALSE - -this is probably gonna be too painful
passive exercise and passive OT/PT is nonpharm treatment
is weight reduction a nonpharm treatment for RA
yes
name 3 classes of pharmacologic therapy that can treat RA
DMARDS
glucocorticoids
NSAIDS
name 3 subclasses of DMARDS used in RA
chemical synthetic compound DMARDS (csDMARDS)
targeted synthetic compounds (tsDMARDS)
biological agents (bDMARDS)
name 4 ACR recommended csDMARDS for RA
name a few not in recommendation
methotrexate
leflunomide
hydroxychloroquine
sulfasalazine
gold
minocycline
azathioprine
cyclosporine
what are the tsDMARDS
the janus kinase inhibitors
true or false
JAK inhibitors are biologics
FALSE
they are tsDMARDS
(targeted synthetic)
name 2 categories of biologic agents used for RA
TNFa antagonists and non TNFs antagonists
name 5 TNFa antagonists biologics used for RA
etanercept
infliximab
adalimumab
golimumab
certolizumab pegol
name 4 non THFa antagonists
what acronym can you use to remember
“ARTS”
abatacept
rituximab
tociluzimab
sarilumab
what does abatacept inhibit
T-lymphocytes
(NOT TNFa blocker)
what does tocilizumab inhibit
IL-6
NOT TNFa blocker
what does rituximib inhibit
B cell
nonTNFa
what does sarilumab inhibit
IL-6
non TNFA blocker
is anakinra in the ACR guideline for RA? what does it block?
NO
blocks IL-1
what does etanercept block
TNFa
what does certolizumab block
TNFa
name 3 JAK inhibitors used for RA
what acronym can you use to remember
“BUT”
barcitinib
upadacitinib
tofacitinib
all end in IB — others dont
can methotrexate be combined with other DMARD??
yes
what is usually the “starter” DMARD for RA?
what can be added from there?
methotrexate
can add steroid like prednisone
then for mod-severe can add another DMARD
do NSAIDS/COX2 inhib and salicylates have a role in RA?
YES
can be used for rapid anto-inflamm and analgesic effects
can be used short term with DMARDS until they kick in - takes weeks
true or false
NSAIDS do NOT alter the course of RA
TRUE - just can help to relieve some symptoms of inflammation and pain
if NSAIDS/salicylates are not efficacious after 2-4weeks for RA, what should be done?
increase the dose or switch the drug
recap – what organ systems are the main target of NSAID side effects
GI
kidney
cardiovascular
how are corticosteroids used in RA?
for acute flareups, limit inflammation and prevent progression
can be used with DMARDS
why might a corticosteroid be given with a DMARD for RA?
2 reasons:
-temporarily relieve some symptoms until DMARD kicks in
-steroid + DMARD may SLOW DOWN joint erosion and inflammation (PROGRESSION)
What is the biggest concern with using steroids for RA
long term use should not be done - serious side effects from chronic treatment
are corticosteroids given IA to RA patients?
NOT NORMALLY - it can be very painful
but it can be done in pts not responding to other treatments and joint is extremely painful
as mentioned, the duration of steroid dosing is limited in RA
explain the limitations PO and IA
PO - lowest dose possible shortest amt time (10mg, 3 months)
IA - 2-3/joint/year
name some potential SE of corticosteroids
hyperglycemia
hypertension
glucose intolerance
osteoporosis
weight gain
cushing’s
hirsutism (unwant hair growth)
atrophy of skin
psychosis
INFECTIONS
HPA suppression
myopathies
glaucoma/cataracts
what is a very important consideration when you’ve been giving corticosteroids long term
do NOTTT stop cold turkey
must taper
can get very bad things like permanent psychosis
in a RA patient taking corticosteroids, what things should regularly be monitored
blood pressure and glucose
electrolytes
intaocular pressure (eye exams)
bone density
when educating a pt taking CS’s long term, what to tell them
watch for signs of infection
regular eye exams
take calcium and vitamin D (MD may consider bisphosphanates to prevent bone loss potentially caused by steroids)
