7: Case Studies Flashcards
When is the peak incidence of RA diagnosis?
Between 4th and 5th decades of life.
RA is more common in:
Males
Females?
Females
Which key feature is NOT included in the diagnosis of RA?
- Symptoms lasting longer than 6 weeks
- Morning stiffness
- Thoraco-lumbar spine pain
- Symmetrical pain and swelling in the hands
- Thoraco-lumbar spine pain
Which diagnostic test would you want to obtain to confirm suspicion of RA diagnosis?
- Rheumatoid factor
- Anti-cyclic citrullinated peptide antibodies (anti-CCP)
- X-rays of the hands
- All of the above
- All of the above
Why is early diagnosis essential? Please choose the best statement.
- The more involved the pain and swelling at baseline, the worse the future will be for the patient.
- Early intervention can make a difference in long-term progression of the disease.
- Seropositive disease is more aggressive, causing erosions and structural damage to the bone.
- All of the above
- All of the above
What other systems can RA affect besides the joints?
- Cardiac system
- Pulmonary system
- Vascular system
- All of the above
- All of the above
What is the first-line treatment of RA?
- Methotrexate
- TNF
- Inhibitors
- Cyclophosphamide
- Actemra
- Methotrexate
According to the BeSt trial:
- Monotherapy is the best way to start treatment
- Combination therapy provides earlier clinical improvement and less progression of joint damage after a year compared to initial monotherapies
- Monotherapy is just as effective as combination treatment in rapidly eliminating clinical symptoms
- Combination therapy provides earlier clinical improvement and less progression of joint damage after a year compared to initial monotherapies
According to the New England Journal of Medicine paper, triple therapy with MTX, sulfasalazine, and Plaquenil is noninferior to treatment with Enbrel and methotrexate. Is this true, and if so, why is this important?
Triple therapy is more cost effective then combination therapy with MTX and Enbrel. The TNF medications are biologics, and they are very costly ($30,000 to $40,000 per year). Use of TNF inhibitors should be used after failure of triple therapy for that reason. But of course if there are side effects, we would move in that direction sooner rather then later.
What joints are involved in psoriatic arthritis that are not involved in RA?
The distal interphalangeal joint (DIPs)
What findings are commonly seen in psoriatic arthritis?
- Dactylitis
- Nail pitting
- Psoriasis
- All of the above
- All of the above
Which is not a feature of PMR diagnosis?
- Diagnosis after the age of 50 but usually seen after age 70.
- Involvement of the hands and feet are important.
- PMR usually affects the shoulders and the hips.
- Inflammatory markers are elevated.
- Involvement of the hands and feet are important.
Patients with PMR are very responsive to low-dose steroids. What is the recommended time frame for tapering, and why?
Any of the following are acceptable answers:
- Greater then one year.
- A taper less than one year has a 70% chance of recurrence of the disease.
- A taper of greater than one year reduces the chance of recurrence to 30%.
What lupus rashes cause scarring of the skin?
- All rashes/lesions cause scarring of the skin.
- Subacute lupus lesions cause scarring.
- Discoid or chronic lesions cause scarring.
- Acute butterfly lesions cause scarring.
- Discoid or chronic lesions cause scarring.
T/F Lupus is a constellation of diverse signs and symptoms that change over time. A butterfly rash means the disease is active.
True
