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19 Cards in this Set
- Front
- Back
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RA
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-AI disease
-chronic, systemic, inflamm -primarily peripheral diarthrodial joints -erosive, potentially destructive arthropathy -unrelated to OA |
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prevalence
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-onset 30-50
-2-3x more common in females -potentially fatal |
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mechanisms of joint damage
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-CHEMICAL, ENZYMATIC,
SYMMETRICAL LOSS OF CARTILAGE -BONE LOSS DUE TO EROSION AND OSTEOPOROSIS -bony swelling -asymmetrical oligo or mono-arthritis -DIP |
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ACR criteria
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1. AM stiffness (longer)
2. 3 or more joints 3. hand involvement 4. symmetry 5. nodules 6. RF 7. radiographic changes |
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history
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1. season of onset
2. AM stiffness 3. Gelling (when the move they feel better) 4. associated illnesses or exposures |
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physical exam
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-symmetry
-soft tissue swelling -PIPs, MCPs, Wrists |
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Labs
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1. anemia
2. thrombocytosis 3. inc ESR, CRP 4. + Rf 5. + ANA 6. + Anti-CCP |
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rheumatoid factor
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-never base dx solely on RF
-not diagnostic -false positives (age, SBE, hep) -false negatives -RF positivity increases with disease duration -high titer diagnosticaly more meaningful -high titer wosre prognosis |
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Anti-CCP: CYCLIC CITRULLINATED PEPTIDE
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-not essential for Dx
-more specific and more snesitive -high titer worse prognosis -helps localize the disease |
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synovial fluid
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-imflamm fluid: WBC >1,000 and PMN >50%
-orders: 1. gram stain 2. cx 3. differential 4. crystal search 5. WBC count |
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radiology
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-symmetrical joint space loss
-PIPs -MCPs -atlanto-axial subluxation -corner erosions of small joints -"windblown deformity"- knees |
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Extra-articular RA
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-systemic sx
-wt loss -anemia -fever -higher lever of RF and anti-CCP |
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extra-articular RA in lungs
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-nodules
-pul interstitial fibrosis (may be the most impt b/c it can be difficult to distinguish from methotrexate pul toxicity) -vasculitis -pleuritis/pericarditis -felty's syndrome |
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mgmt advanced
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-early, aggressive interventiona improves outcome
-methotrexate -bio agents -combo therapy |
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worst prognosis
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-hight anti-CCP
-high RF -erosions -high ESR or CRP -extra-articular manifestations |
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oral steroid
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-Pro:
1. tx flares 2. minimize or control dz activity -Con: 1. higher dose or duration means more SE 2. difficult to stop -most follow: 1. gluc 2. bone density 3. BP |
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methotrexate
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-gold standard tx
-first line tx -parenteral absorbed better than PO -Toxicities: hematologic, rash, oral ulcers, inc LFTs, GI, folic acid def -precautions: liver hx, alcohol mod |
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second line drugs
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-Arava
-Imuran -Remicade- IV Q2 months -Abatacept -Rituximab |
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when to refer to rheumatologist
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-uncertain dx
-confusing lab rasults -uncomfortable with DMARd or bio use -pt not responding -erosions or other radiographic changes -SE |
