Session 4 Cm- Rheum -1- Ra

Front 1

What is the peak onset for R.A.

Back 1

age 25-45

Front 2

Who suffers more from R.A. M or F

Back 2

F>M 3:1

Front 3

When is a women likely to experience relief from R.A.

Back 3

improves during pregnancy and flares 4-6 weeks post partum

Front 4

What effect does R.A. have on mortality rates in general

Back 4

Pts with rheumatoid arthritis have higher mortality than Gen'l population

Front 5

What are the classification criteria for R.A.

Back 5

at least 4 of the following for >6wks; morning stiffness lasting >1hour, swelling in 3 or more joint areas, swelling in hand joints, symmetric joint swelling, rheumatoid nodules, rheumatoid factor, erosions or osteopenia on hand x-ray

Front 6

What is the pathophysiology of R.A. I.e. what is the underlying cause

Back 6

swollen inflamed synovial membrane

Front 7

What is the pathognomonic cellular finding for R.A.

Back 7

Pannus (hypertrophic Synovium)

Front 8

What is the problem with pannus (hypertrophic Synovium)

Back 8

normally synovium doesn't cover cartilage in R.A. you get invasion of synovium into the cartilage, tendons and ligaments

Front 9

What joints are classically involved in R.A.

Back 9

MCPs, PIPs (80%), Wrist 80%, Knee 80%, Ankle Subtalar 80%, MTPs 90%, shoulder 60%, C-Spine 40%, TMJ 30%

Front 10

What joints are noticeably absent in involvement in R.A.

Back 10

Spine except C-Spine

Front 11

Which hand joint is spared in R.A.

Back 11

DIP joints are typically spared

Front 12

If you find ulnar deviations, interossei atrophy and subluxations what stage of R.A. is your patient in

Back 12

advanced stages

Front 13

Outside of the joint you can get signs and symptoms of R.A. name 5

Back 13

Rheumatoid Nodules, Sjogren's syndrome, Felty's syndrome, vasculitis, Rheumatoid lung, cardiac disease, neuromyopathy, inflammatory eye disease, osteoporosis, lymphadenopathy, hyperviscosity, cryoglobulinemia, dermatologic, amyloidosis

Front 14

If pt has rheumatoid nodules what other positive finding will you always find

Back 14

Always Rheumatoid Factor +

Front 15

Your pt presents with R.A. and sever neck pain radiating to occiput, have diminished motor power in arms/legs, dysesthesias of the fingers/feet, marble sensation in the limbs/trunk, jumping legs, disturbed bladder function what could be causing this

Back 15

Myelopathic leading to spinal cord damage from degeneration of the C-SPINE

Front 16

What is Sjogren's syndrome

Back 16

autoimmune exocrinopathy, sicca symptoms (dry eyes, mouth, vagina, tracheo-bronchial dryness) associated with SS-A (RO) and SS-B (LA) antibodies and is tx symptomatically

Front 17

What is the schirmer's test for

Back 17

tests for tear production can help identify Sjogren's or other malfunction in tear formation

Front 18

What are nail fold infarcts

Back 18

small vessel vasculitis that can indicated R.A.

Front 19

What lab findings are you likely to find in R.A.

Back 19

+ rheumatoid factor, Anti CCP antibody, Elevated ESR or CRP, Anemia, Thrombocytosis, ANA +, Hyperglobulinemia, Leukopenia/granulocytopenia, glucose in body fluids very low

Front 20

Besides R.A. what other disease may show rheumatoid positive finding

Back 20

Syphilis, sarcoidosis, SLE, SBE, T.B., Leprosy, Parasitic infections, Viral Disease, advanced age, autoimmune disease

Front 21

What are the two areas of R.A. that we can effectively tx

Back 21

alleviate pain, slow rate of joint damage

Front 22

What is one of the limitations of DMARDs for tx of R.A.

Back 22

high discontinuation rate (toxicity/efficacy) needs continued monitoring, has delayed onset of action

Front 23

What type of drug are the following- Hydroxychloroquine (Plaquenil), Sulfasalazine (Azulfidine), Gold Compounds, Azathioprine (Imuran), D-Penicillamine (D-pen & Cuprimine), Cyclosporine (Sandimmune), Methotrexate (Rheumatrex, Trexall), Leflunomide (Arava)

Back 23

DMARDs

Front 24

What are the pros of using methotrexate

Back 24

long term clinical experience, favorable rate of continuing therapy, proven efficacy in moderate-severe RA

Front 25

What are the Cons of using methotrexate

Back 25

Lab Monitoring 4-8wks, Toxicities; hepatic, myelosuppression, pulmonary

Front 26

What are the pros of using Leflunomide

Back 26

Well absorbed PO, early onset of action, stabilized benefit for long-term use, selectively target autoimmune lymphocytes to reduces AEs

Front 27

What are the cons of Using Leflunomide

Back 27

Lack of Clinical Experience, Toxicities- hepatic, GI, Teratogenic

Front 28

How does etanercept (Enbrel) help tx RA

Back 28

Soluble TNA alpha receptor binds TNF-alpha a pro inflammatory cytokine helps reduce inflammation

Front 29

When would etanercept be indicated

Back 29

moderate to severe RA prior DMARDS failure

Front 30

What are the adverse rxn from using etanercept

Back 30

injection site reaction, infection (including TB), Cephalgia, Rhinitis

Front 31

How does Infliximab (Remicade) work in tx of RA

Back 31

Chimeric Monoclonal anti-TNF antibody, blocks action of TNF has rapid onset of action used in combo with MTX

Front 32

When would Infliximab be indicated for use

Back 32

Moderate to Severe RA with prior DMARDS failure

Front 33

What are the adverse rxns of using Infliximab (Remicade) in RA

Back 33

URI, cephalgia and Nausea, Increased incidence of TB

Front 34

How does Adalimumab (Humira) work in tx of RA

Back 34

Fully humanized monoclonal anti-TNF antibody blocks action of TNF, used in combo with MTX, rapid onset of action

Front 35

When would you use Adalimumab in tx of RA

Back 35

moderate to severe RA prior DMARDS failure

Front 36

What are the s/e to using Adalimumab (Humira)

Back 36

URI, Cephalgia, Nausea, increased incidence of TB