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PHM 702 pulm, tox & rheumatoid > RA > Flashcards

RA Flashcards

1
Q

RA prodromal symptoms

A
  • fatigue, fever, weakness, weight loss, myalgias
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2
Q

RA disease flares and trigger

A
  • trigger: viral inf
  • sudden inc in signs/symptoms, last days to months
  • established disease. is greater than 6 months
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3
Q

RA signs and symptoms

A
  • Symmetric swelling of hands, wrist, ankles, feet; inflammation, warm over joints, nodules, grip weakness, deformity, muscle atrophy
  • occurs w/ use or at rest; joint pain w/ stiffness lasting >6 wks, prodromal symptoms, dec range of motion, joint deformity
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4
Q

RA extra-articular involvement

A

rheumatoid nodeules
pulmonary complications
vasculitis
ocular manifestations
cardiac issues
hematologic involvement
lymphadenopathy
amyloidosis
osteoporosis

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5
Q

RA diagnosis

A

Labs: Inc ESR/CRP, rheumatoid factor, ACPAs, ANAs

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6
Q

ACR/EULAR criteria

A
  • identifies early signs and symptoms
  • 4 domains: joint involvement, serology, acute phase reactants, duration of symptoms
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7
Q

Distinguishing RA from OA

A
  • age: variable (peds and elderly)
  • onset: gradual or sudden
  • joint symptoms: generalized
  • Joint involvement: small joints of hands, wrist and feet
  • joint stiffness: prolonged >1hr
  • joint pain: with or w/o use
  • symmetry: bilateral
  • auto-ab: present
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8
Q

Non-disease modifying therapy components and goals

A
  • for symptom relief
  • need combo with DMARDs
  • improve/maintain functional status
  • slow destructive joint changes
  • achieve disease remission/ low disease activity
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9
Q

Non pharm options

A
  • Rest, weight loss, pain coping skills
  • Physical occupation therapy (assisted devices)
  • severe: surgery
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10
Q

Non- disease modifying drugs

A
  • nsaids
  • corticosteriods (low doses can be used long term for refractory disease)
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11
Q

what to do in RA patient w/ mod-high disease with prior csDMARD use other than MTX

A

switch to MTX mono

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12
Q

which DMARD to start with LOW disease activity

A

Hydroxycholorquine > sulfasalazine> Mthotrextate> Lefluonomide

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13
Q

which DMARD to start with HIGH disease activity

A

Methotrexate

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14
Q

what to do in RA patient w/ mod-high disease who is on oral MTX and not at target

A

Switch to subQ methotrexate

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15
Q

what to do in RA patient w/ mod-high disease w/o poor prognostic factors / patient preference

A

add another csDMARD

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16
Q

what to do in RA patient w/ mod-high disease w/ poor prognostic factors / patient preference

A

add tsDMARD or bDMARD

17
Q

what are poor prognostic factors

A
  • high disease activity
  • early presence of erosion
  • antibody positivity
18
Q

Which agents are csDMARDs

A

Methotrexate
Leflunomide
Sulfasalazine
Hydroxychloroquine

19
Q

Methotrexate monitoring and dosing clinical pearl

A

WEEKLY
rule out pregnancy at baseline
chest x ray at baseline
Take with folic acid to helpo with ADR

20
Q

Leflunomide monitoring

A

rule out pregnancy at baseline

21
Q

Hydroxychloroquine monitoring

A

ophthalmologic exam at baseline and every 3 months

22
Q

Sulfasalazine montioring

A

Rule out G6PD deficiency at baseline risk for porphyria

23
Q

Which agents are bDMARDs

A
  • TNFi: etanercept, infliximab, adalimumab, golimumab, certolizumab
  • nonTNFi: abatacept, rituximab, tocilizumab, anakinra, sarliumab
24
Q

clinical pearls of nonTNFI, adequate trial

A
  • adequate trial of 6 months
  • premed w/ antihistamines, acetaminophen, glucocorticosteriods
25
Q

bDMARDs monitor, vacc

A
  • Test for latent TB and hep B before initiating and during treatment
  • Monitor CBC, LFTs
  • Vacc: Pneumococcal, non active influenza, Hep B
26
Q

Which agents are tsDMARDS and BBW

A

JAK inhs
- Tofacitinib, Baricitinib, Upadacitinib
- BBW: opportunistic infections, lymphoma and other malignancies

27
Q

What agents to use in HF Class 3-5

A

non-TNFi or tsDMARD

28
Q

what agents to avoid in liver disease

A

MTX and LEF

29
Q

What to do if patient has active or latent TB

A
  • Latent: may use non-TNFI or JAK after 1 month of TB treatment
  • Active: may use non-TNFI or JAK after completing treatment course

PHM 702 pulm, tox & rheumatoid (15 decks)

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