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ortho-rheum > RA + Juvenile Idiopathic Arthritis > Flashcards

RA + Juvenile Idiopathic Arthritis Flashcards

1
Q

what are 5 symptoms of rheumatoid arthritis?

A

morning stiffness
fatigue
low-grade fever
myalgias
decreased energy

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2
Q

what is the most common sign of rheumatoid arthritis?

A

polyarthritis joint swelling

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3
Q

what are 3 characteristics of RA?

A

symmetric
in small joints
erosive polyarthritis

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4
Q

what is occasionally seen initially in RA?

A

monoarticular disease (in one joint)

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5
Q

what is associated with decreased risk of RA?

A

breastfeeding

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6
Q

what are the 3 most common joints of the hands affected by RA?

A

PIP
MCP
wrists

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7
Q

what is the most common joint of the feet affected by RA?

A

MTP

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8
Q

deformity in which the PIP joint is flexed and the DIP joint is hyperextended

A

boutonniere deformity

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9
Q

which joint is spared in RA?

A

DIP joint

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10
Q

deformity in which the MCP joint is flexed, PIP is hyperextended, and DIP is flexed.

A

swan neck deformity

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11
Q

where in the cervical spine is commonly involved in RA?

A

C1-C2

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12
Q

how does cardiac involvement present in RA?

A

pericarditis

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13
Q

how does hematologic involvement present in RA?

A

normocytic normochromic anemia

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14
Q

a patient with RA experiences manifestations of felt’s syndrome. what is this?

A

splenomegaly with neutropenia

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15
Q

how does ocular involvement present in RA?

A

keratoconjunctivitis sicca

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16
Q

what extra-articular manifestation is pathognomonic for RA?

A

subcutaneous rheumatoid nodules

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17
Q

what patients with RA is subcutaneous rheumatoid nodules most strongly associated with?

A

seropositive patients (+RF)

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18
Q

what are 3 prominent symptoms to indicate RA?

A

morning stiffness x 1-2 hrs for at least 6 weeks
symmetric swelling of 4+ joints for at least 6 weeks
subcutaneous nodules

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19
Q

what is a hallmark feature of RA?

A

persistent symmetric polyarthritis of hands and feet

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20
Q

what lab can be done for RA that is nonspecific and may be absent in early disease?

A

RF

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21
Q

what lab is very specific for RA?

A

anti-cyclic cirullinated peptide (CCP)

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22
Q

what 3 basic labs should be ordered for RA?

A

CBC w/diff
CMP
ESR/CRP

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23
Q

what will xrays show in a patient with RA? (4)

A

erosions
soft tissue swelling
ulnar deviation
joint space narrowing in later disease

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24
Q

what will an ultrasound show in a patient with RA? (2)

A

erosions
synovial hypertrophy

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25
Q

what is the NSAID rule for treatment of RA?

A

use only one NSAID at a time

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26
Q

which NSAID can be used to treat RA? what can be used with it to protect gastric mucosa?

A

naproxen (naprosyn)
PPI

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27
Q

which NSAID is 2nd line for RA and has less risk of GI bleed?

A

celecoxib

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28
Q

when treatment can be used for pain in RA when NSAIDs are contraindicated?
what’s an ADR?

A

acetaminophen
liver toxicity

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29
Q

what treatment offers the most effective short-term relief for RA, and is used as a bridge until DMARDS starts working?

A

corticosteroids

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30
Q

what do corticosteroids help with in RA?

A

active disease or flare-ups

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31
Q

which corticosteroid can be used for RA?
what’s an alternative if patient doesn’t want to gain weight?

A

low dose prednisone
intra-articular steroid injection

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32
Q

what is the mainstay of management in RA?

A

DMARDs

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33
Q

immunosuppressive drugs that reduce M&M by limiting complications, slowing progression of disease, and preserve joint function

A

DMARDs

34
Q

how long do DMARDs take to work?

A

6 weeks or longer

35
Q

what are the two 1st line DMARDs used for RA?

A

methotrexate
leflunomide

36
Q

what is the initial DMARDs of choice for RA?

A

methotrexate

37
Q

how is methotrexate used for RA?

A

once a week
pill OR subcutaneous

38
Q

3 ADRs of methotrexate?

A

liver toxicity
renal toxicity
teratogenicity

39
Q

how is leflunomide used for RA?

A

daily

40
Q

4 ADRs of leflunomide?

A

liver toxicity
teratogenicity
alopecia
bone marrow suppression

41
Q

what should be monitored when using methotrexate? leflunomide?

A

liver and renal function

liver function

42
Q

what are the 2 alternative DMARDs used for RA?

A

hydroxychloroquine
sulfasalazine

43
Q

which DMARDs requires eye examination, but is okay to use in pregnant women or women planning to become pregnant?

A

hydroxychloroquine

44
Q

what is hydroxychloroquine dosing based on?

A

weight

45
Q

what should be checked before treating a patient’s RA with sulfasalazine? why?

A

G6PD
risk of hemolysis

46
Q

in which patients should sulfasalazine be avoided? (3)

A

lupus +
sulfa allergy
aspirin allergy

47
Q

newer protein drugs used for RA that reduce the signs and symptoms of synovitis

A

biologics

48
Q

before starting biologics, what should patients be screened for? (2)

A

TB with Chest Xray
hepatitis panel

49
Q

what is the most common type of arthritis seen in kids and teens?

A

juvenile idiopathic arthritis (JIA)

50
Q

what criteria must be met to diagnose a patient with CHRONIC Juvenile idiopathic arthritis?

A

chronic inflammatory arthritis > 6 weeks

51
Q

what is the age of onset of juvenile idiopathic arthritis?

A

younger than 16 yrs

52
Q

what are the 6 types of Juvenile Idiopathic Arthritis?

A

oligoarthritis
polyarthritis
systemic juvenile idiopathic arthritis
psoriatic
enthesis-related
undifferentiated

53
Q

the most common JIA that affects 4 or less joints during the duration of the disease

A

oligoarthritis

54
Q

a 2 year old patient presents with asymmetrical joint pain in the knees, ankles, and wrists and has uveitis. Dx?

A

oligoarthritis

55
Q

what lab will be positive in oligoarthritis? what does it indicate?

A

ANA
asymptomatic uveitis

56
Q

JIA that affects more than 5 joints during the first 6 months of disease

A

polyarthritis

57
Q

a patient presents with weight loss, fatigue, low fever, and pain in 6 joints. Dx?

A

polyarthritis

58
Q

peaks at 1-3 years old and then later in adolescence, has symmetrical distribution affecting larger joints like cervical spine and TMJ. Patient has a negative RF. Dx?

A

seronegative polyarthritis

59
Q

what is the least common of all JIA?

A

seropositive polyarthritis

60
Q

onset during early adolescence, has symmetrical distribution, can be erosive, and affects large and small joints like the rheumatoid nodules over elbows and achilles. Patient has a positive RF. Dx?

A

seropositive polyarthritis

61
Q

a patient presents with arthritis in their joint and a fever for 2 weeks. They also have an erythematous rash that comes and goes. Dx?

A

systemic JIA

62
Q

one of the following must be present for a patient to be diagnosed with systemic JIA: (4)

A

transient erythematous rash
lymphadenopathy
hepatomegaly/splenomegaly
serositis

63
Q

what is the criteria for psoriatic JIA?

A

arthritis + psoriasis

OR

arthritis + two:
dactylitis
nail pitting/onycholysis
psoriasis in 1st deg relative

64
Q

a 3 year old patient presents with chronic uveitis. what do they likely have?

A

psoriatic JIA

65
Q

inflammation at site where tendons and ligaments insert into bones and strongly associated with HLA-B27.

A

enthesis-related JIA

66
Q

a patient presents with asymmetric peripheral arthritis, anterior uveitis, IBD, and pain in the hip. Dx?

A

enthesis-related JIA

67
Q

patient meets criteria for more than one subtype or no subtype

A

undifferentiated

68
Q

what will RF+ patients show in xray late in the course of JIA? (2)

A

joint space narrowing
erosion

69
Q

what is the best imaging tool to detect early bone erosions in JIA?

A

ultrasound

70
Q

what will help make a definitive diagnosis of JIA?

A

synovial biopsy

71
Q

what screening test should be done in patients with anterior uveitis?

A

slit lamp exam (ophthalmological screening)

72
Q

what is the first line treatment for JIA?

A

Indomethacin (NSAID)

73
Q

what is the second line treatment for JIA?

A

methotrexate (DMARDs)

74
Q

what can be used to treat JIA if patient does not respond to 3 months of methotrexate?

A

biologics

75
Q

what is the treatment for polyarthritis JIA with moderate/severe disease activity?

A

biologics

76
Q

what can be used in JIA for severe systemic involvement, bridge therapy for DMARDs, and for acute anterior uveitis?

A

short-course systemic steroids

77
Q

what are 3 articular complications associated with JIA?

A

joint destruction/deformity
limb length discrepancy
growth retardation

78
Q

what are 2 extra-articular complications associated with JIA?

A

blindness (chronic anterior uveitis)
pericarditis/pleuritis

79
Q

what is a common extra-articular complication of systemic JIA?

A

macrophage activated syndrome

80
Q

prognosis of JIA?

A

most resolve by puberty

ortho-rheum (27 decks)

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