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Specialty Medicine > Osteoarthritis > Flashcards

Flashcards in Osteoarthritis Deck (62):
1

What is the major difference between osteoarthritis and RA, in terms of abnormal bone findings?

OA is degenerative, and bone spurs form

RA causes erosion of the bones

2

What are the two general forms of OA?

-Primary = idiopathic
-Secondary = 2/2 other dz

3

What is the most common cause of secondary OA in the US?

Obesity

4

What, generally, is OA?

Degeneration of cartilage and its underlying bone within a joint, as well as bony overgrowth

5

What are the radiographic findings of OA? (3)

-Joint space narrowing
-Subchondral sclerosis
-Osteophyte formation

6

Which extremity joint is not affected with OA?

Elbow

7

Is RA symmetric or asymmetric involvement? Single or multiple?

Symmetric, polyarthritis

8

What are bouchard's nodes?

DIP nodes in OA

9

What are the palpable characteristic difference of nodes in RA vs OA?

OA = hard
RA = squishy

10

What are the non-pharmacological treatments for OA? (4)

-Weight loss / exercise
-Joint protection
-Assistive devices
-PT/OT

11

Is exercise good for OA joints?

Moderate exercise, Yes

12

What is the major guide for treatment of OA?

How much it affects pt's life

13

What are the meds that change the disease course of OA?

None

14

What are the meds that are used to treat OA?

-NSAIDs
-Glucocorticoids
-Tramadol

15

Which is better for pain with OA: acetaminophen or an NSAID?

NSAID

16

What is the antidepressant that can improve OA pain?

Duloxetine
hyaluronates

17

What are the recommended intra articular therapies for OA?

Glucocorticoids

18

What is the only NSAID that is available in topical form?

Diclofenac

19

True or false: NSAIDs are generally safe to use in OA

False, due to side effects of chronic use

20

What is the MOA of celecoxib?

Specific COX-2 inhibitor

21

True or false: there is no platelet effects with celecoxib

True

22

What is the major side effect of celecoxib?

Potential increase in Cardiovascular events

23

What are the 3 overall goals of treating OA?

-Pain control
-Improve QOL / function
-Avoid toxicity

24

When is the age of onset for RA?

30-50 years

25

True or false: RA has increased risk of mortality. Why or why not?

True--Chronic inflammation increases chances of CV disease

26

What is the role of RA drugs in the mortality rate associated with RA?

Increases life span

27

What are the criteria for RA?

-Morning stiffness
-Arthritis of 3+ joints
-Arthritis of hand joints
-Symmetric arthritis
-Rheumatoid nodules
-Serum Rh factor
-Radiographic changes

28

In order to diagnose RA, how many joints needed to affected?

3+ or the hands

29

How long does the morning stiffness need to last to meet criteria for RA?

hour or more

30

How does the morning stiffness compare between OA and RA?

RA = lasts hours
OA = resolves within an hour

31

What is Rh factor?

IgM bound to the Fc portion of IgG

32

What is the antibody that is fairly specific to RA?

Anti-CCP (cyclic citrullinated peptide)

33

What is the pathophysiology of RA?

Pannus forms within a joint, causing joint destruction and synovitis

34

What are the radiological findings of RA?

Joint space narrowing and bone erosion

35

How are the radiological findings between OA and RA different?

RA is symmetric joint narrowing, without bone spurs

OA, the medial portion of the joint degraded first. Bone spurs are present

36

Where are rheumatoid nodules usually found?

Extensor surfaces, usually on the forearm or hand

37

What are the ocular issues that arise from RA?

-Dry eyes, leading to ulceration
-Scleritis

38

What type of hypersensitivity reaction is RA?

III and IV

39

What are the popliteal findings of RA?

Bakers cysts

40

What is the HLA haplotype that is associated with RA?

HLA-DR4

41

What are the two HLA haplotypes associated with celiac disease?

HLA-DR2 and HLA-DR8

42

Which improves with use, and which improves with rest: OA vs RA?

RA improves with use
OA improves with rest

43

What is caplan's syndrome?

a combination of RA and pneumoconiosis that manifests as intrapulmonary nodules, which appear homogenous and well-defined on chest X-ray

44

Why is it important to refer RA early?

Stop the morbidity associated with joint destruction

45

What is the role of corticosteroids in treating RA?

Bridge therapy for the onset of action of second line agents

46

What is the role of NSAIDs in RA?

Might help with pain, but not disease modifying, and has multiple side effects

47

What is the drug of choice for RA? Is it used in monotherapy?

Methotrexate
Can be used in monotherapy or combination

48

What are the side effects of methotrexate?

-Hepatic fibrosis
-Myelosuppression
-Pulmonary toxicity

49

What is the MOA of methotrexate?

competitively inhibits dihydrofolate reductase (DHFR), an enzyme that participates in the tetrahydrofolate synthesis

50

What, generally, is the Sharp's score?

Scoring method for determining the severity of RA, based on joint space narrowing in hands and feet

51

What is the role of DMARDs in treating RA?

-may slow down or prevent joint damage
-Frequently used in combination

52

What is the MOA, use, and side effects of Rituximab?

-Monoclonal antibody against CD20, to target B cells
-NHL, RA
-Increases risk of progressive encephalopathy

53

What is the MOA and use of Vemurafenib?

-Small molecule inhibitor of forms of the B-RAf kinase with the V600E mutation
-Metastatic melanoma

54

What is the MOA, use, and side effects of Bevacizumab?

-Ab against VEGF to inhibit angiogenesis
-Solid tumors
-Hemorrhage and impaired wound healing

55

What is the MOA, use, and side effects of Imatinib?

-Tyrosine kinase inhibitor of bcl-abl of the Philadelphia chr fusion gene in CML
-Fluid retention

56

What is the MOA, use, and side effects of Trastuzumab?

-Ab against HER-2
-HER2+ breast cancer
-Cardiotoxic ("heart-ceptin damages the heart")

("tras-2-zumab")

57

What is the MOA, use, and side effects of Tamoxifen?

-SERM
-ER+ breast cancer
-Increases risk of endometrial cancer

58

What is the MOA of etanercept?

Receptor for TNF-alpha

59

What are the side effects of anti-TNF-alpha drugs?

-Expensive
-Increased risk of infections
-malignancy

60

What are the two major infectious complications from TNF alpha inhibitor use?

Granulomatous diseases like TB and histo

61

What are the cytokine that are responsible for initiating the formation, and maintenance of granulomas?

Th1 cells secrete gamma IFN to activate macrophages to form granuloma

TNF-alpha from macrophages induce and maintain granuloma formation

62

What must always be tested for prior to starting anti-TNF-alpha drugs?

TB