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Intro to D&D Midterm > Saad - Rheumatoid Arthritis > Flashcards

Saad - Rheumatoid Arthritis Flashcards

1
Q

true or false

rheumatoid arthritis is a systemic disorder

A

true

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2
Q

which is more debilitating and concerning and why- osteoarthritis or rheumatoid arthritis?

A

rheumatoid arthritis

it is potentially deforming and more systemic than osteo – can affect other organs

EXTRA-ARTICULAR INVOLVEMENT

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3
Q

true or false

RA is not an inflammatory disorder

A

false - it is

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4
Q

what is polyarthritis

A

potentially can affect RA patients — 5 or more joints have RA

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5
Q

does RA ever affect children?

A

yes, under 16 it’s called juvenile RA

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6
Q

true or false

pts with RA have increased incidence in premature death

A

true

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7
Q

which gender is more prone to developing RA

A

female

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8
Q

name 3 ways in which the course of RA can differ from patient to patient and explain each

A

polycyclic
monocyclic
progressive

polycyclic - symptoms come and go repeatedly

monocyclic - comes, goes, and never comes back (rare)

progressive - keeps getting worse every cycle

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9
Q

name 4 general causes of RA

A

genetic
environmental
effects of advancing age
changes in muscskel and immune system

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10
Q

which is characteristic of having LESS signs of inflammation - OA or RA

A

OA

RA has lot of heat swelling stiffness - doesnt HAVE to be pain

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11
Q

name 4 joints most commonly affected by RA

A

hands
wrists
ankles
feet
(smaller joints)

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12
Q

RA is often uni or bi lateral?

A

bi

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13
Q

prolonged morning stiffness - longer than 30 mins - RA or OA?

A

RA

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14
Q

in which chronic arthritis do patients usually have better functionality

A

osteo

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15
Q

in RA, symptoms are present for _ weeks or more

A

6 weeks

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16
Q

what is subluxation

A

partial dislocation of a joint

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17
Q

____ and ____ are possible with advanced RA disease

A

subluxations and deformities

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18
Q

what are general, nonspecific implications of RA

A

generalized fatigue, weakness, and decreased mood

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19
Q

how can RA have extra-articular involvement involving the lungs

name 2 things

A

rheumatoid nodule formation on extensor or pleural lining

interstitial lung disease or pleural disease

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20
Q

can RA affect the CV system?

A

yes

vasculitis
myocarditis
pericarditis
abnormal cardiac conduction

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21
Q

name 2 ways RA can affect blood cell count

A

anemia
felty’s syndrome (swollen spleen, dec WBC)

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22
Q

can RA affect the eyes?

A

yes

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23
Q

in radiography OA vs RA, explain how you can differentiate the 2

A

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

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24
Q

true or false

there is no single diagnostic lab test for RA

A

TRUE

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25
Q

as mentioned, there is no single RA diagnostic test

name 5 that may be used to indicate RA (but not definitively)

A

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

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26
Q

true or false

erythrocyte sedimentation rate (ESR) is elevated in RA patients and normal in OA patients

A

TRUE – due to presence of inflammation in RA patients

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27
Q

which diagnostic test is most specific to RA and what is it testing for?
can it be used to diagnose RA

A

no

lookinf for an anticyclic citrullinated peptide antibody - most specifically mutated citrullinated vimentin

28
Q

true or false

lab tests alone are used to diagnose RA

A

false - multi factors

clinical presentation + lab results

29
Q

synovial fluid analysis of an RA patient will reveal what?

A

high WBC when there’s no crystals or infection

30
Q

true or false

joint replacement of a joint affected by RA will get rid of the arthritis in the joint

A

FALE – this is true for OA

RA is autoimmune – it will just attack

31
Q

if remission of RA cannot be achieved, what is the goal according to ACR and EULAR

A

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

32
Q

why does RA treatment involved shared clinical decision making between pts and HCP

A

the medications have a lot of side effects

33
Q

treatment in RA should involve measuring _____ and adjust ______ as appropriate

A

measuring disease activity and adjust therapy as appropriate

34
Q

true or false

active exercising is a nonpharmacologic treatment for RA

A

FALSE - -this is probably gonna be too painful

passive exercise and passive OT/PT is nonpharm treatment

35
Q

is weight reduction a nonpharm treatment for RA

A

yes

36
Q

name 3 classes of pharmacologic therapy that can treat RA

A

DMARDS
glucocorticoids
NSAIDS

37
Q

name 3 subclasses of DMARDS used in RA

A

chemical synthetic compound DMARDS (csDMARDS)

targeted synthetic compounds (tsDMARDS)

biological agents (bDMARDS)

38
Q

name 4 ACR recommended csDMARDS for RA

name a few not in recommendation

A

methotrexate
leflunomide
hydroxychloroquine
sulfasalazine

gold
minocycline
azathioprine
cyclosporine

39
Q

what are the tsDMARDS

A

the janus kinase inhibitors

40
Q

true or false

JAK inhibitors are biologics

A

FALSE

they are tsDMARDS
(targeted synthetic)

41
Q

name 2 categories of biologic agents used for RA

A

TNFa antagonists and non TNFs antagonists

42
Q

name 5 TNFa antagonists biologics used for RA

A

etanercept
infliximab
adalimumab
golimumab
certolizumab pegol

43
Q

name 4 non THFa antagonists

what acronym can you use to remember

A

“ARTS”

abatacept
rituximab
tociluzimab
sarilumab

44
Q

what does abatacept inhibit

A

T-lymphocytes

(NOT TNFa blocker)

45
Q

what does tocilizumab inhibit

A

IL-6

NOT TNFa blocker

46
Q

what does rituximib inhibit

A

B cell

nonTNFa

47
Q

what does sarilumab inhibit

A

IL-6

non TNFA blocker

48
Q

is anakinra in the ACR guideline for RA? what does it block?

A

NO
blocks IL-1

49
Q

what does etanercept block

A

TNFa

50
Q

what does certolizumab block

A

TNFa

51
Q

name 3 JAK inhibitors used for RA
what acronym can you use to remember

A

“BUT”

barcitinib
upadacitinib
tofacitinib

all end in IB — others dont

52
Q

can methotrexate be combined with other DMARD??

A

yes

53
Q

what is usually the “starter” DMARD for RA?
what can be added from there?

A

methotrexate

can add steroid like prednisone

then for mod-severe can add another DMARD

54
Q

do NSAIDS/COX2 inhib and salicylates have a role in RA?

A

YES

can be used for rapid anto-inflamm and analgesic effects

can be used short term with DMARDS until they kick in - takes weeks

55
Q

true or false

NSAIDS do NOT alter the course of RA

A

TRUE - just can help to relieve some symptoms of inflammation and pain

56
Q

if NSAIDS/salicylates are not efficacious after 2-4weeks for RA, what should be done?

A

increase the dose or switch the drug

57
Q

recap – what organ systems are the main target of NSAID side effects

A

GI
kidney
cardiovascular

58
Q

how are corticosteroids used in RA?

A

for acute flareups, limit inflammation and prevent progression

can be used with DMARDS

59
Q

why might a corticosteroid be given with a DMARD for RA?

A

2 reasons:

-temporarily relieve some symptoms until DMARD kicks in

-steroid + DMARD may SLOW DOWN joint erosion and inflammation (PROGRESSION)

60
Q

What is the biggest concern with using steroids for RA

A

long term use should not be done - serious side effects from chronic treatment

61
Q

are corticosteroids given IA to RA patients?

A

NOT NORMALLY - it can be very painful

but it can be done in pts not responding to other treatments and joint is extremely painful

62
Q

as mentioned, the duration of steroid dosing is limited in RA
explain the limitations PO and IA

A

PO - lowest dose possible shortest amt time (10mg, 3 months)

IA - 2-3/joint/year

63
Q

name some potential SE of corticosteroids

A

hyperglycemia
hypertension
glucose intolerance
osteoporosis
weight gain
cushing’s
hirsutism (unwant hair growth)
atrophy of skin
psychosis
INFECTIONS
HPA suppression
myopathies
glaucoma/cataracts

64
Q

what is a very important consideration when you’ve been giving corticosteroids long term

A

do NOTTT stop cold turkey
must taper
can get very bad things like permanent psychosis

65
Q

in a RA patient taking corticosteroids, what things should regularly be monitored

A

blood pressure and glucose
electrolytes
intaocular pressure (eye exams)
bone density

66
Q

when educating a pt taking CS’s long term, what to tell them

A

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)

67
Q
A

Intro to D&D Midterm (29 decks)

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