Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
40 Cards in this Set
- Front
- Back
|
What are the rheumatic (= rheumatologic) diseases?
|
A group of diseases characterized by pain and inflammation in joints and connective tissues. They are systemic. Sometimes called collagen-vascular diseases.
|
|
|
Inflammatory rheumatic diseases involve what kind of immunity?
Give up to 3 examples of such diseases. |
Involves innate immunity.
- gout - osteoarthritis - pseudogout |
|
|
Immunologically-mediated rheumatic diseases involve what kind of immunity?
Give up to 3 examples of such diseases. |
Involves adaptive immunity.
- rheumatoid arthritis - systemic lupus erythematous - spondyloarthropathies - polymyositis/dermatomyositis - systemic sclerosis (scleroderma) - Wegener's granulomatosis - giant cell arteritis |
|
|
What is gout?
(Eg of an inflammatory rheumatic disease) |
An acute, hot joint.
Usually involves first metatarsophalangeal (MTP) joint Not in pre-menopausal females Diagnosis is done by arthrocentesis (using syringe to collect synovial fluid from a joint capsule) |
|
|
What are 4 acute interventions / treatments for gout?
(Eg of an inflammatory rheumatic disease) |
(1) NSAIDs*
(2) steroids (3) colchicine* (4) IL-1 inhibitors *caution in renal failure |
|
|
What are the 11 clinical manifestations / diagnostic criteria of systemic lupus erythematosus?
(Eg of an immunologically-mediated rheumatic disease) |
/ Malaysian disco photographer orator artfully serenades renaissance neutral hemostat, immortalizing antiquity. /
(1) malar rash (2) discoid rash (3) photosensitivity (4) oral ulcers (5) arthritis (6) serositis - pericarditis and pleuritis (7) renal disorder - proteinuria (8) neurological disorder - psychosis, seizures (9) hematologic disorders - hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia (10) immunologic disorders - anti-DNA, anti-Sm (11) antinuclear antibody |
|
|
Who is systemic lupus erythematosus (SLE) most common in?
(Eg of an immunologically-mediated rheumatic disease) |
Young African-American and Hispanic females
|
|
|
What are 5 drug therapies used in lupus?
(Eg of an immunologically-mediated rheumatic disease) |
(1) Hydroxychloroquine - esp for skin disease; changes lysosomal pH and interferes with antigen processing and presentation
(2) Glucocorticoids (3) NSAIDs - for arthritis, serositis (4) Cyclophosphamide - for nephritis (5) Mycophenylate mofetil - immunosuppressive |
|
|
What is osteoarthritis?
(Eg of an inflammatory rheumatic disease) |
A form of arthritis, characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth, leading to pain and joint stiffness. It's inflammatory.
X-ray reveals marginal bony hooks at DIP (distal interphalangeal) joint |
|
|
What are 3 treatments (ish) for osteoarthritis?
(Eg of an inflammatory rheumatic disease) |
(1) weight loss, exercise, aqua therapy
(2) acetaminophen / cautious NSAIDs (3) Hyalan (Synvisc) intra-articularly |
|
|
How can you distinguish between an inflammatory rheumatic problem from a non-inflammatory rheumatic problem by pain?
|
Worse pain in AM -> inflammatory
Worse pain in PM (after bearing weight all day long) -> non-inflammatory |
|
|
How can you distinguish between an inflammatory rheumatic problem from a non-inflammatory rheumatic problem by stiffness?
|
Stiffness in AM -> inflammatory
No frequent stiffness -> non-inflammatory |
|
|
How can you distinguish between an inflammatory rheumatic problem from a non-inflammatory rheumatic problem by redness?
|
Redness present -> inflammatory
Redness absent -> absent |
|
|
How can you distinguish between an inflammatory rheumatic problem from a non-inflammatory rheumatic problem by swelling?
|
Soft swelling present -> inflammatory
Bony swelling present -> non-inflammatory |
|
|
Detail 4 types of drugs used to treat rheumatic diseases.
|
(1) Drugs w only analgesic action simple analgesics - eg: acetaminophen
(2) Drugs w both analgesic and anti-inflammatory action: NSAIDs - eg: aspirin (3) Drugs w only anti-inflammatory action: corticosteroids - eg: prednisone (4) Drugs which specifically affect the course of a disease: disease modifying drugs |
|
|
List some disease-modifying drugs (DMARDs) for rheumatoid arthritis (RA).
|
- hydroxychloroquine
- methotrexate - sulfasalazine - leflunomide - azathioprine - cyclosporine - leflunomide - anti-TNF antibodies: etanercept, infliximab, adalimumab, golimumab, certolizumab - interleukin-1 receptor antagonists (IL-Rα) - abatacept - rituximab - tofacitinib - tocilizumab - anakinra |
|
|
List some disease-modifying drugs for gout.
|
Drugs lowering serum uric acid levels by decreasing uric acid synthesis:
- allopurinol - febuxostat Drugs lowering serum uric acid levels by increasing uric acid elimination: - probenecid |
|
|
What is a general approach in the management of rheumatoid arthritis (RA) in primary care?
|
Establish diagnosis early.
Treat with a DMARD (disease-modifying antirheumatic drug) or refer early, w/i 3 mos. Consider adding NSAID, low dose steroid Monitor response and toxicity. |
|
|
What should be the first drug tried in the treatment of osteoarthritis (OA)?
|
Acetaminophen
|
|
|
What is rituximab?
|
An anti-CD20 antibody that depletes B cells. It is a DMARD.
|
|
|
What is abatacept?
|
A co-stimulation modulator. It is a DMARD.
|
|
|
What is tocilizumab?
|
An IL-6 receptor antagonist. It is a DMARD.
|
|
|
What is tofacitinib?
|
A Janus associated kinase inhibitor. It is a DMARD.
|
|
|
What are some adverse effects of TNF antagonists?
|
- bacterial, mycobacterial (eg: TB), or fungal infection
- immunological, including injection reactions and antinuclear antibodies, eg: lupus - neurological, eg: deyelinating syndromes - malignancy, eg: lymphoma |
|
|
What is anakinra?
|
An IL-1 receptor antagonist. It is a DMARD.
|
|
|
What are some combinations we would use in combination therapy for RA?
|
- methotrexate & hydroxychloroquine
- methotrexate & hydroxychloroquine & sulphasalazine - methotrexate & TNF antagonist - methotrexate & leflunomide - methotrexate & abatacept - methotrexate & rituximab - methotrexate & anakinra - methotrexate & cyclosporine |
|
|
In biologics, what does "-cept" indicate?
|
fusion of a receptor to the Fc part of human IgG1
|
|
|
In biologics, what does "-mab" indicate?
|
A monoclonal antibody (mAb)
|
|
|
In biologics, what does "-ximab" indicate?
|
A chimeric mAb
|
|
|
In biologics, what does "-zumab" indicate?
|
A humanized mAb
|
|
|
What is etanercept?
|
Two soluble p75 TNF receptors bound to the Fc portion of IgG. It is a TNF inhibitor. It is a biologic.
|
|
|
What is infliximab?
|
A chimeric mAb. It is a TNF inhibitor. It is a biologic.
|
|
|
What is adalimumab?
|
A TNF inhibitor. It is a biologic.
|
|
|
What is anakinra?
|
A recombinant human IL-1Ra that differes from the native human protein in that it is not glycosylated and has an additional N-terminal methionine. It is an IL-1 inhibitor. It is a biologic.
|
|
|
What is canakinumab?
|
An anti-IL-1β mAb with a longer half life than anakinra. It is an IL-1 inhibitor. It is a biologic.
|
|
|
What is an IL-1 trap?
|
A high-affinity blocker of cytokine action
|
|
|
What is tocilizumab?
|
It competes for both the membrane-bound and soluble-forms of human IL-6 receptor, thereby inhibiting the binding of the native cytokine (IL-6) to its receptor. It is an IL-6 inhibitor. It is a biologic.
|
|
|
What is abatacept?
|
A soluble fusion protein that prevents Cd28 from binding to its counter-receptor, CD80/CD82 (B7.1 or B7.2) due to the former's higher affinityf for it. It is a costimulation blockade agent. It is a biologic.
|
|
|
What is rituximab?
|
A B cell depleting monoclonal anti-CD20 antibody, either by B-cell apoptosis, growth arrest, antibody-dependent complement-mediated cell lysis, or Fc receptor gamma-mediated antibody-dependent cytotoxicity. It is a B cell depleter. It is a biologic.
|
|
|
Summarize the 3 biologic approaches to treatment of rheumatic diseases
|
(1) interfere with cytokine function
(2) inhibit the second signal required for T cell activation (3) deplete B cells |
