Saad - Rheumatoid Arthritis Flashcards by amanda kastel

true or false

rheumatoid arthritis is a systemic disorder

true

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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

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true or false

RA is not an inflammatory disorder

false - it is

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what is polyarthritis

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

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does RA ever affect children?

yes, under 16 it’s called juvenile RA

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true or false

pts with RA have increased incidence in premature death

true

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which gender is more prone to developing RA

female

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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

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name 4 general causes of RA

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

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

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

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name 4 joints most commonly affected by RA

hands
wrists
ankles
feet
(smaller joints)

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RA is often uni or bi lateral?

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

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in which chronic arthritis do patients usually have better functionality

osteo

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in RA, symptoms are present for _ weeks or more

6 weeks

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what is subluxation

partial dislocation of a joint

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____ and ____ are possible with advanced RA disease

subluxations and deformities

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what are general, nonspecific implications of RA

generalized fatigue, weakness, and decreased mood

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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

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can RA affect the CV system?

yes

vasculitis
myocarditis
pericarditis
abnormal cardiac conduction

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name 2 ways RA can affect blood cell count

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

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can RA affect the eyes?

yes

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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

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true or false

there is no single diagnostic lab test for RA

TRUE

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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)