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48 Cards in this Set
- Front
- Back
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RA is all of the following EXCEPT:
a) chronic b) systemic c) idiopathic d) Non-suppurative e) curative f) inflammatory g) arthropathy h) diarthrodial joints I) extra-articular features |
e) curative. RA cannot be cured, it can only be managed.
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what is the most likely cause of activation of RA?
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activation of the "T" cell by an antigen in a genetically susceptible pt
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what does synovial proliferative lead to? which will do what?
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Pannus; which will invade cartilage and bone
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what are the two most important cytokines to RA?
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TNF-alpha
IL-1 |
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T/F
RA affects more women than men. |
TRUE
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what is the peak age for RA?
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25-45
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what happens to the symptoms of RA during pregnancy? what ideas has that led to?
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the disease symptoms improve during pregnancy and flare 4-6 weeks post-partum. This has led people to believe that RA is a hormone associated disease.
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T/F
RA is a benign Dz? |
False..
RA can cause significant morbidity |
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what are the two most common mortality causes associated with RA?
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infection 9.4%, malignancy 20%
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who fits the criteria of people that should be tested for RA?
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1) have at least 1 joint w/ definite clinical synovitis that cannot be better explained by another disease.
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what is the score necessary to say that it is definite RA?
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>6/10
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what are the four categories of tests involved to rule in/out RA?
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a) joint involvement
b) serology c) acute phase reactants d) duration of symptoms |
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what percentage of individuals with RA will be sero-positive?
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70-80%
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what antibody seems to be indicative of patients with developing RA?
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anti-ccp
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where are the locations that are SPECIFICALLY RA?
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temporo-mandibular
sterno-clavicular acromino-calvicular elbow wrist MCPs ankle, subtalar MTPs |
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RA does not involve the spine except?
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cervical
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what are the locations that are SPECIFICALLY OA?
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Lumbar spine
Hip 1st carpometacarpal DIP |
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what are the locations shared by both the RA and OA?
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shoulder
PIP knee |
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why are the joints hyperpigmented after an attack of RA?
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w/ inflammation of the joints, the RBCs leak out and stain the tissues with hemosideron
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how does the texture of RA PIP differ from an OA PIP?
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RA: feels like the tip of your nose
OA: Feels like a bony protuberance. |
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what are the two hand deformities associated w/ RA? what are they due to?
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boutonniere deformity and swan-neck deformity. Due to damage to tendons and ligaments.
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what percentage of RA patients will present with rheumatoid nodules?
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25%
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what is sero-positivity always associated with?
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rheumatoid nodules
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what is sjogren's syndrome?
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AI exocrinopathy- antibodies are produced and directed against the glands and ducts. Pt usually presents with pain w/ sexual intercourse, chronic cough,etc
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Leukopenia, specifically granulocytes in an RA pt, what should you be thinking?
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felty's syndrome
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what does rheumatoid lung look like?
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lung cancer
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what are the thirteen extra-articular manifestations of RA?
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rheymatoid nodules
sjogren's syndrome felt's sundrome vasculities rheumatoid lung cardiac disease neuroromyopathy inflammatory eye dz osteoporosis lymphadenopathy hyperviscosity cryoglobulinemia dermatologic amyloidosis |
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in C1-C2 subluxation, where does RA cause inflammation?
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around the transverse ligaments of the atlas
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in what position is subluxation of C1-C2 more prominent?
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flexion
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what are the four inflammatory diseases mentioned in RA?
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scleritis
scleromalacia small vessel vasculitis sjogren's syndrome |
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which sjogren's is associated with SS-A and SS-B + antibodies?
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primary
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what is schirmer's test?
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its a test for sjogren's syndrome where you place a piece of paper over the lower lid and w/n five minutes in a normal person, you will have produced a minimum of 15 mm of tears. If the tears collected are less than 5 mm, then sjogren's.
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what are the three most important laboratory findings in RA?
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Rheumatoid Factor +
Anti-CCP antibody Elevated ESR or CRP |
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RF+ and anti-ccp has what percentage of specificity for RA?
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99.5%
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T/F
NSAIDs do not halt disease progression |
TRUE
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what is the major category of drugs used to tx RA?
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DMARDS
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what is the gold standard for RA? which other one is used as well?
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methotrexate; Leflunomide
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what do you always give with methotrexate?
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folic acid
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what labs must be monitored with methotrexate? how often?
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every 2 months:
CBC LFTS CREAT AST ALT |
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should pregnancy women be on methotrexate? what about leflunomide?
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no, no... both are teratogenic,
Methotrexate is abortifacent. Leflunomide is teratogenic |
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a pt with atalectasis presents with RA. What should you NOT prescribe them?
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methotrexate: Contraindicated in people with lung problems
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what category of drugs as made the biggest impact on RA?
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biologic therapies: esp the TNF alpha inhibitors
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which biologic therapy is 25% mouse and 75% human?
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infliximab
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which biologic therapy is 100% human but must be IVed?
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etanercept
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which biological therapy is 100% human and can be given SubQ?
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Humira
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what risk increases with biologic therapies?
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infection
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what are two tests that you must run before placing your pt on a biologic therapy? what are you checking for?
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PPD or quantiferon gold test
Hep B test if pt is positive in either one you cannot give them a biologic therapy in latent TB and in Heb B |
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T/F
both Hep B and C are contraindications for biologic therapies. |
FALSE
Hep B is a contraindication, but Hep C is not |
