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124 Cards in this Set
- Front
- Back
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Which disease is autoimmune?
osteoarthritis RA |
RA
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60-70% of RA patients test positive for this
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rheumatoid factor
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Patients with these antibodies will have a false negative rheumatoid factor
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IgA and IgG
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True or False: rheumatoid factor may be positive in patients without RA
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True
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True or False: everyone with RA test positive for rheumatoid factor
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False
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These three diseases are types of types of arthritis that will not have a positive RF test
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psoriatic arthritis
ankylosing spondylitis arthritis associated with irritable bowel disease |
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In RA, what are the characteristics of antinuclear antibodies that differentiates it from lupus?
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in RA, ANA is positive but not double stranded
in lupus, ANA is positive and double stranded |
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What are the characteristics of teh synovial fluid in RA?
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turbid
less viscous less glucose |
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What are the characteristics of erythrocyte sedimetation rate in RA?
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elevated
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What is the characterisitic of C-reactive protein in RA?
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elevated
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What diseases are secondary to RA?
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anemia
thrombocytosis leukopenia/thrombocytopenia leukocytosis |
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In RA, these symptoms have a slow onset over weeks to months
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prodrome
stiffness/myalgias preceding joint swelling |
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afternoon fatigue, low grade fever, weakness, loss of appetite and joint pain are all symptoms of this condition. This condition have a slow onset in RA.
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prodrome
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In RA, these symptoms have an abrupt onset
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fever
polyarthritis depression anxiety fatigue anorexia weight loss |
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What joint pain are involved in RA but uncommon in OA?
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wrists
hands elbows shoulders knees ankles |
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What joint pain are common in OA, but not is RA?
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hips
lower back neck |
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True or False: RA usually affects joints asymmetrically
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False: RA affects joints symmetrically
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What are the extra articular involvement of RA?
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rheumatoid nodules
vasculitis pulmonary complications ocular manifestations cardiac involvement felty's syndrome lympadenopathy |
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Which extensor surfaces do rheumatoid nodules affect?
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hands
forearms elbows |
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What areas of the body do rhrumatoid nodules effect?
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extensor surfaces
pressure points lung pleural lining meninges |
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What percent of RA patients have rheumatoid nodules?
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20%
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Do patients with rheumatoid nodules require specific treatment if they are asymptomatic?
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no
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What disease am I:
an ocular manifestation of RA inflammation in the sclera, episclera, cornea, and conjunctiva |
keratoconjunctivitis
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What is the treatment for keratoconjunctivitis?
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artificial tears
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True or False: rheumatoid nodules can develop on the sclera
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True
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What are the 7 criteria used for diagnosing RA?
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morning stiffness in and around joints lasting longer than 1 hour before max involvement
soft tissue swelling of greater than 3 joint areas swelling of proximal interphalangeal, metacarpophalangeal or wrist joints symmetric arthritis subcutaneous nodules positive RF radiographic erosions or periarticular in hand or wrist joints |
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How many of the criteria for diagnosing RA must a patient have to be diagnosed with RA?
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4
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Which criteria for diagnosing RA must be present for longer than 6 weeks?
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morning stiffness in and around joints lasting longer than 1 hr before max involvement
soft tissue swelling of greater than 3 joint areas swelling of proximal interphalangeal, metacarpophalangeal or wrist joints symmetric arthritis |
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In terms of bilateral or unilateral arthritis, which one(s) does RA have?
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bilateral
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in terms of bilateral or unilateral arthritis, which one(s) does OA have?
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bilateral or unilateral
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What are the 6 criteria for complete clinical RA remission?
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morning stiffness not greater than 15 min
no fatigue no joint pain no joint tenderness or pain on motion no soft tissue swelling or joints or tendon sheaths erythrocyte sedimation rate less than 30/hr for women or 20/hr for men |
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How many of the criteria for diagnosing RA must a patient have to be diagnosed with RA?
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4
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Which criteria for diagnosing RA must be present for longer than 6 weeks?
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morning stiffness in and around joints lasting longer than 1 hr before max involvement
soft tissue swelling of greater than 3 joint areas swelling of proximal interphalangeal, metacarpophalangeal or wrist joints symmetric arthritis |
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In terms of bilateral or unilateral arthritis, which one(s) does RA have?
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bilateral
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in terms of bilateral or unilateral arthritis, which one(s) does OA have?
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bilateral or unilateral
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What are the 6 criteria for complete clinical RA remission?
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morning stiffness not greater than 15 min
no fatigue no joint pain no joint tenderness or pain on motion no soft tissue swelling or joints or tendon sheaths erythrocyte sedimation rate less than 30/hr for women or 20/hr for men |
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How many of the criteria for complete clinical RA remission and for how long do patients have to meet in order to be considered in complete remission?
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must meet at least 5 for greater then 2 consecutive months
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What are the treatment goals for RA?
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complete remission
improve and maintain functional status reduce mortality* |
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What is the ultimate goal of RA treatment?
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complete remission
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What is the practical goal of RA treatment?
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improve or maintain functional status
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What are the non-pharmacological treatment options for RA?
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rest
physical/occupational therapy assistive devices weight reduction surgery |
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When should DMARDs be initiated for RA treatment
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within 3 months of diagnosis
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True or False: RA patient on early DMARD treatment have reduced mortality rate to the same as patients without RA
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True
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What is the first line of treatment RA?
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methotrexate or other DMARD (+/- NSAID, +/- prednisone) within first 3 months
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If initial treatment of methotrexate or DMARD does not work, what is the next line of therapy?
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switch to a different DMARD
use a combo of DMARDs use a biologic DMARD or biologic DMARD with DMARD combo |
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If patients do not respond to DMARD combo, what is the next line of therapy?
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try different combination
use triple drug therapy (DMARD + biologic) add low dose prednison for longer term consider second line DMARD |
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What is considered the DMARD of choice?
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methotrexate
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What is the dose of methotrexate?
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7.5-15mg weekly
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What is the onset of action of methotrexate?
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2-3 weeks
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True or False: supplementing folate decreases the efficacy of methotrexate
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False
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What are the toxicities of methotrexate?
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myelosuppression
hepatic fibrosis cirrhosis pulmonary infiltrates/fibrosis stomatitis rash |
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pre-treatment liver biopsies are recommened for patients with what conditions?
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excess alcohol use
ongoing hepatitis B or C recurring elevation of AST/ALT |
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What are the monitoring parameters of methotrexate?
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symptoms (SOB, N/V/D, cough, mouth problems, jaundice)
CBC AST/ALT liver biopsies for some pts |
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What is the loading dose of leflunomide?
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100mg for 3 days
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What is the onset of action of leflunomide?
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1 month
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What is the maintenance dose of leflunomide?
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20mg daily
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How is leflunomide eliminated?
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enterohepatic recirculation
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How long does it take to eliminate leflunomide?
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several months
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What class of drugs help to make leflunomide elimination more rapid?
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cholestyramine
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What are the toxicities of leflunomide?
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hepatitis
GI distress alopecia |
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What are the monitoring parameters of leflunomide?
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N/V/D
gastitis alopecia jaundice |
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What is the onset of action of hydroxychloroquine?
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up to 6 weeks
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When should patients on hydroxychloroquine be assessed for response?
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6 months
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What are the adverse effects of hydroxychloroquine?
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OCULAR and dermatologic toxicity
GI toxicities |
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What toxicities does hydroxychloroquine not have that other DMARDs may have?
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myelosuppression, hepatic and renal toxicity
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What are the monitoring parameters of hydroxychloroquine?
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visual changes
scotomata rash alopecia n/v/d annual slit-lamp exam |
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According to the american college of rheumatology, what should patients on hydroxychloroquine be screened for?
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retinopathy
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What hydroxychloroquine risk am I:
< 6.5mg/kg/d HCQ for < 5yrs |
low risk
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What hydroxychloroquine risk am I:
> 6,5mg/kg/d HCQ or > 5 yrs of treatment or high body fat or liver/kidney disease or > 60yrs or pediatric |
high risk
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What drug am I:
cleaved into sulfapyridine and 5 aminosalicylic acid by colonic bacteria |
sulfasalazine
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What is the onset of action of sulfasalazine?
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2 months
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What are the adverse effects of sulfasalazine?
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GI
dermatological myelosuppression |
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What does sulfasalazine do to the effects of warfarin?
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potentiates the effects of warfarin
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What can be used to control the dermatological adverse effects of sulfasalazine?
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antihistamine
corticosteroids |
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What can be done to reduce the GI effects of sulfasalazine?
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titrate to full dose
divide dose |
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What are the monitoring parameters of sulfasalazine?
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photosensitivity
rash n/v CBC |
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methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine fall under what class of drugs for the treatment of RA?
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DMARD
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gold, D-penicillamine, cyclophosphamide, cyclosporine, azathioprine, and minocycline fall under what class of drugs for RA?
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DMARD
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Caution should be taken in patients with these conditions when administering biologic DMARDs
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patients with MS, optic neuritis, CHF
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True or False: biologic DMARDs increases risk of malignancy
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True
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When should TB skin test be given in patients using biologic DMARDs
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before treatment
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Patients with this condition needs to initiate TB prophylaxis before being given biologic DMARDs
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patients with previous exposure or high risk of developing TB
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When are biologic response modifiers indicated?
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during and after initial DMARD failure
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What drug am I:
anti-TNF agent used as a biologic DMARD |
etanercept
infliximab |
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What adverse effects have been reported with etanercept?
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pancytopenia
demyelinating syndromes like MS |
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What is the dose of etanercept for the treatment of RA?
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25mg SC BIW or 50mg weekly
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What is the dose of infliximab for the treatment of RA?
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3mg/kg IV at 0, 2, and 6 weeks
then every 8 weeks |
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What drug is given concomitantly with infliximab to discourage formation of antibodies?
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methotrexate
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What is the adverse effects of infliximab?
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lupus-like syndrome
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What drug am I:
human IgG antibody to TNF |
adalimumab
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What is more antigenic, adalimumab or infliximab?
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infliximab
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What dose of adalimumab is given for the treatment of RA?
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40mg SC every 2 weeks
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What drug am I:
cause B-lymphocyte depletion |
rituximab
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How long does the therapeutic effects of rituximab last?
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up to 48 weeks after initial treatment
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How long does the ADR of rituximab last?
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up to 24 hours after 1st infusion
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What are the ADR of rituximab?
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BP changes
cough rash (pruritis) |
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What is the black box warnings for rituximab?
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fatal infusion reactions and severe mucocutaneous reactions
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What drug am I:
interleukin 1 receptor antagonist |
anakinra
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True or False: patients not responding to anti-TNF will not respond to IL-1ra
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False: patients may respond to IL-1ra if they don't respond to anti-TNF
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What is the ADR of corticosteroids?
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adrenalcortical suppression
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What drug is used as bridge therapy as DMARDs are initiated?
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corticosteroids
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What does REMS stand for?
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risk evaluation and mitigation strategies
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If patients are nonadherent, how should corticosteroids be administered?
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IM depot
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If patiens have few joints affected, how should corticosteroids be administered?
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intraarticular injections
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What is the maximum dose of intraarticular injections of corticosteroids?
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no more than 2-3 times per year
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What is the american college of rheumatology's positon on therapeutic substitution?
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they opposed therapeutic substitions by pharmacist, but allow generic substitions
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What drugs can be used to treat severe RA and can be used during pregnancy?
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hydroxychloroquine
azathioprine |
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What may be the drug of choice for RA patients who are pregnant?
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sulfasalazine
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What RA drugs require hepatitis B vaccinations?
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leflunomide
methotrexate biologic DMARDs |
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What RA drugs require flu vaccines?
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hydroxychloroquine
leflunomide methotrexate minocycline sulfasalazine biologic DMARDs |
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Live vaccinations should be avoided in this RA drug
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biologic DMARDs
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Which RA drugs require pneumonia vaccination?
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leflunomide
methotrexate sulfasalazine biologic DMARDs |
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These RA drugs do not require maintenance monitoring
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biologic DMARDs
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What are the lab tests required for maintenance of NSAIDs in RA?
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SrCr/BUN
CBC serum salicylate level stool guaiac |
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What are the maintenace labs of methotrexate in RA?
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CBC w/ Platelets
AST albumin |
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What are the maintenance labs of leflunomide?
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CBC with platelets
ALT |
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What are the maintenance labs of hydroxychloroquine in RA?
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ophthalmoscopy
amsler grid |
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What are the maintenance labs for sulfasalazine in RA treatment?
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CBC with platelet
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What are the maintenance labs for aurandin in RA treatment?
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urine analysis
CBC with platelet |
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What are the maintenance labs for gold in RA treatment?
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urine analysis
CBC with platelet |
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What are the maintenance labs for D-penicillamine?
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urine analysis
CBC with platelet |
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What are the maintenance labs for cyclophosphamide in RA treatment?
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urine analysis
CBC with platelet |
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What are the maintenance labs for cyclosporine in RA treatment?
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blood pressure
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What are the maintenance labs for corticosteroids in RA treatment?
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glucose
blood pressure |
