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;
21 Cards in this Set
- Front
- Back
|
137. Appearance of synovial fluid w/septic arthritis?
|
a. Turbid, purulent.
|
|
|
138. WBC and PMN in septic arthritis?
|
a. WBC: Usually >50,000
b. PMN: >70%. |
|
|
139. Other findings with septic arthritis?
|
a. Synovial fluid culture positive for most cases of bacterial arthritis except gonococcal (only 25% are positive).
|
|
|
140. Positive prognostic indicators in RA?
|
a. High RF titres
b. Subcutaneous nodules c. Erosive arthritis d. Autoantibodies to RF. |
|
|
141. What are joint changes in RA more extensive than in OA?
|
a. Bc the entire synovium is involved in RA.
b. Note: Osteophytes (characteristic of OA) are NOT present in RA. |
|
|
142. How does Juvenile RA differ?
|
a. Begins before age 18.
b. Extra-articular manifestations may predominate (Still’s disease) c. Or d. Arthritis predominates. |
|
|
143. Principles of treatment for RA?
|
a. The goals of treatment are to prevent or halt joint destruction and to come as close to clinical remission as possible while avoiding the toxicity of anti-RA meds.
b. Tx must be individualized to the pt. c. A tx regimen that works for one pt may not work for another. |
|
|
144. Symptomatic tx of RA?
|
a. NSAIDs are the drugs of choice for control of pain.
b. They play an important role in controlling inflammation and should be part of most tx regimens. c. Steroids (low-dose)- Use these if NSAIDs do not provide adequate relief. i. Short-term tx may be appropriate. ii. Avoid long-term, high dose steroids. |
|
|
145. Value of steroids for RA?
|
a. Long term, LOW-DOSE steroids may actually alter the course of the disease (have been shown to diminish radiographic progression).
b. More studies are needed before this can be considered a disease-modifying drug. |
|
|
146. General principles of Disease-modifying Drugs for RA?
|
a. Can reduce morb/mort (by nearly 30%)- by limiting complications, slowing progression of disease, and preserving joint function.
b. Should be initiated early (at time of diagnosis). c. They have a slow onset of action (6 weeks or longer for effect to be seen), so begin treating RA while waiting for the disease-modifying therapy to take effect d. once effect is evident gradually taper and discontinue NSAIDs and corticosteroids and Cont. disease modifying program. |
|
|
147. What is the most popular disease modifying drug right now?
|
a. Methotrexate
|
|
|
148. In addition to methotrexate, what two other first-line agents are used for RA?
|
a. Hydroxychloroquine
b. Sulfasalazine |
|
|
149. When is improvement seen with RA using methotrexate?
|
a. Initial improvement is seen in 4 to 6 weeks.
b. Nearly 80% of treated patients will experience moderate to excellent symptomatic benefit from treatment c. remission is rare |
|
|
150. Side effects of methotrexate?
|
a. GI upset
b. oral ulcers (stomatitis) c. mild alopecia d. bone marrow suppression e. hepatocellular injury f. idiosyncratic interstitial pneumonitis, which may lead to pulmonary fibrosis |
|
|
151. What precautions should you take with methotrexate?
|
a. Closely monitor liver and renal function
b. Supplement folate |
|
|
152. What is the utility of hydroxychloroquine?
|
a. Is an alternative first-line agent for RA , but usually not as effective as methotrexate
|
|
|
153. What is the negative of the hydroxychloroquine?
|
a. It requires an eye exam every six months because of risk of visual loss due to retinopathy (although quite rare).
|
|
|
154. Utility of sulphasalazine for RA?
|
a. Is an alternative first-line agent, but less effective than methotrexate
|
|
|
155. What are the second-line agents for the treatment of RA?
|
a. Gold compounds
b. Penicillamine. c. Azathioprine. d. Cyclosporine |
|
|
156. what two surgeries are used for RA?
|
a. Synovectomy (arthroscopic): decreases joint pain and swelling but does not prevent x-ray progression and does not improve joint range of motion
b. Joint replacement surgery for severe pain unresponsive to conservative measures |
|
|
157. Note: with respect to RA, combination therapy with first-line drugs (methotrexate, hydroxychloroquine, and sulphasalazine) produces higher remission rates.
|
157. Note: with respect to RA, combination therapy with first-line drugs (methotrexate, hydroxychloroquine, and sulphasalazine) produces higher remission rates.
|
