Ra Diagnosis And Treatment

Front 1

Rheumatoid Factor is present in about ___% of cases at presentation?

Back 1

50%

Front 2

The goals of RA therapy include (4 items)?

Back 2

1. Control disease activity
2. Alleviate pain
3. Maintain function
4. Maximize quality of life

Front 3

True or False?

The symptoms of RA may appear and disappear.

Back 3

True.

Front 4

The ESR and C-reactive protein tests are ____?

Back 4

Markers for inflammation.

Front 5

What is the hallmark syptom of RA?

Back 5

Morning stiffness.

Front 6

What are the radiological findings characteristic of RA (4 items)?

Back 6

1. Symmetric involvement
2. Loss of cartilage
3. Bone erosions
4. Thinning of bone next to the joint.

Front 7

What are the initial steps in the management of RA?

Back 7

Performing a baseline evaluation of the patient and estimating the prognosis.

Front 8

True or False?

In early RA, pain, swelling, and tenderness are perceived to be localized to the joints.

Back 8

False.

Front 9

According to the ACR guidelines, what are the ultimate long-term goals in managing RA?

Back 9

1. To prevent or control joint damage
2. To prevent loss of function
3. To decrease pain

Front 10

According to the ACR criteria, what are objective evidence of disease activity?

Back 10

1. Tender, swollen joints
2. Elevated ESR
3. Elevated CRP

Front 11

In the list of criteria for the classification of RA, the patient must have ____ of seven criteria to classify as having RA.

Back 11

Five.

Front 12

The earliest stmptoms of RA are sometimes referred to as the _____?

Back 12

Prodrome.

Front 13

Which 3 bDMARD's are administered by infusion?

Back 13

1. Remicade
2. Orencia
3. Rituxan

Front 14

What are the 4 classic symptoms of RA?

Back 14

1. Fatigue
2. Anorexia
3. Weakness
4. Pain and stiffness

Front 15

What is the predominant x-ray change that results from synovitis, from pannus?

Back 15

Synovitis- joint-space narrowing.
Pannus- joint erosions.

Front 16

What is the average delay from the onset of the disease to the time of diagnosis?

Back 16

Nine months.

Front 17

Features that may help make a diagnosis early in the course of RA include...?

Back 17

1. Subcutaneous nodules
2. Elevated RF
3. WBC's in the synovial fluid
4. Bone demineralization and erosions of the affected joints on x-ray.

Front 18

What are the 5 major categories of diagnositic criteria?

Back 18

1. Symptoms of active disease
2. Objective evidence of disease activity
3. Mechanical joint problems
4. Systemic disease
5. Evidence of damage on x-ray.

Front 19

What are considered objective evidence of disease activity (3)?

Back 19

1. Tender and swollen joints
2. Elevated ESR
3. Elevated CRP

Front 20

What 5 categories are recommended by the ACR to evaluate the activity of RA, establish a baseline for comparison when the disease progresses, or to assess response to therapy?

Back 20

1. Subjective
2. Physical examination
3. Laboratory
4. Other tests
5. Radiography

Front 21

Typically, symptoms start in the _____ and the ______?

Back 21

1. Small joints of the hands (PIP and MCP)
2. Toes

Front 22

Swelling at which joint causes compressive neuropathy?

Back 22

Elbow.

Front 23

In RA, patients have what type of anemia?

Back 23

Normochromic, normocytic or "the anemia of chronic disease".

Front 24

What are Rheumatoid Factors?

Back 24

Antibodies that bind Fc fragments of the host's IgG molecule and cause an autoimmune response.

Front 25

True or False?

The presence of RF is diagnostic of RA.

Back 25

False.

Front 26

What "auto-antibodies" are believed to be the most specific for RA?

Back 26

Anti-CCP (cyclic citrullinated proteins). Present in 60-70% of RA patients at diagnosis, 90-98% specific for RA.

Front 27

The HAQ (Health Assessment Questionnaire) provides the physician with an evaluation of what?

Back 27

The degree of the patient's disability.

Front 28

Which radiographic evaluation shows the greatest sensitivity for detecting and monitoring bone erosions?

Back 28

MRI.

Front 29

What usually causes the delay in diagnosis of RA?

Back 29

Nonspecific nature of the intitial symptoms.

Front 30

According to the ACR, the ultimate long-term goals in managing RA are to ___? (3 items)

Back 30

1. Prevent or control joint damage.
2. Prevent loss of function.
3. Decrease pain.

Front 31

What is the primary focus of physical therapy?

Back 31

To increase the range of motion of a joint.

Front 32

What is the cornerstone of treatment for RA?

Back 32

Drug therapy.

Front 33

What 4 DMARD's are available for the treatment of RA?

Back 33

1. Methotrexate
2. Paquenil (hydroxychloroquine)
3. Sulfasalazine
4. Arava (lefunomide)

Front 34

Which 3 bDMARD's are considered anti-TNF-alpha agents?

Back 34

Enbrel (etanercept)
Remicade (infliximab)
Humira (adalimumab)

Front 35

Which bDMARD is cosidered a T-cell costimulation blocker?

Back 35

Orencia (abatacept)

Front 36

Which bDMARD is cosidered a B-cell targeted therapy?

Back 36

Rituxan (rituximab)

Front 37

Which bDMARD is considered an IL-1 inhibitor?

Back 37

Kineret (anakinra)

Front 38

What is the only COX-2 inhibitor currently available by prescription?

Back 38

Celebrex (celecoxib)

Front 39

Prednisone, the most commonly used glucocorticoid, should rarely be used in doses higher than ___mg/day to treat articular manifestations of RA.

Back 39

10 mg/day.

Front 40

Which DMARD is considered the "gold standard" in the treatment of RA?

Back 40

Methotrexate

Front 41

What are the dosing guidelines for MTX (and drug form)?

Back 41

Available as a pill, liquid, or injection QW.
Started at 12.5mg/wk, increased to 20-25mg/wk.

Front 42

What are the dosing guidelines for Sulfasalazine (and drug form)?

Back 42

Taken as a pill BID.
Started at 500mg/day and increased slowly to 2000-3000 mg/day.

Front 43

What are the dosing guidelines, mechanism of action, precaution for use with MTX, and available form of the drug for Arava?

Back 43

Taken as a pill QD.
Usual dose is 20 mg/day, however should be started at 10mg/day when used with MTX. Inhibits the proliferation of B and T cells.

Front 44

What are the primary sources of TNF-alpha?

Back 44

Monocytes and macrophages, T-cells.

Front 45

Which drug classes are considered first-line, second-line, and third-line therapies for RA?

Back 45

First-line: NSAID's and glucocorticoids.
Second-line: DMARD's.
Third-line: bDMARD's.

Front 46

How do bDMARD's treat RA?

Back 46

Interfere with signaling pathways involved in inflammation.