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Rheum > RA > Flashcards

RA Flashcards

1
Q

Patient with RA now with elevated Cr. Thoughts?

A

Secondary amyloidosis

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2
Q

Is renal amyloid protein dissolvable with Rx of RA?

A

It is!!! If we are able to control the inflammation. No one DMARD is above than the other—> GOAL is to normalize CRP.

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3
Q

What are the 6 drug classes for RA

A
  1. CsDMARD (4)
  2. BDMARD- TNF inhibitor
  3. BDMARD - CTLA-4 inhibitor
  4. BDMARD - IL-6 inhibitors
  5. BDMARD - anti-CD20
  6. TsDMARD- JAK inhibitors
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4
Q

What are the 16 drugs used for RA treatments at this time

A
  1. MTX
  2. Leflunomide
  3. SSZ
  4. HCQ
  5. Adalimumab
  6. Infliximab
  7. Certolizumab
  8. Golimumab
  9. Etanercept
  10. Abatacept
  11. Rituximab
  12. Tocilizumab
  13. Sarilumab
  14. Tofacinib
  15. Baricitinib
  16. Ubatacitinib
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5
Q

What is a serious infection for guidelines and trials

A

Anything that puts the patient in the hospital or requires IV antibiotics

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6
Q

Can you use combination MTX and TNF from the get go based on RA ACR guidelines?

A

You ABSOLUTELY can if they have poor prognostic factors. It is a conditional recommendation to use MTX monotherapy.

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7
Q

ACR 2021 guidelines: DMARD naive patient with low disease activity, order of drug choice

A

HCQ>SSZ>MTX>leflunomide

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8
Q

Patient not tolerating oral MTX well, what can you do? Should we just jump to a TNF (follow ACR)

A

Nope!!
1. Split the dose
2. Increase folic acid
3. Can switch to folinic acid

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9
Q

Patient on MTX developed nodules, next steps? ACR based

A

Switch to a different drug

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10
Q

A patient has preexisting lung disease, do you use MTX?

A

Yes if it is mild, stable, or incidentally detected on imaging

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11
Q

Do you really have to stick to MTX if the patient has lung disease?

A

Absolutely not!! It is a conditional recommendation and not necessarily needs to be done if you or patient are not comfortable

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12
Q

Which degree of heart failure can you not use TNF agents?

A

NYHA class 3 or 4

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13
Q

Patient with a lymphoproliferative disease, preferred agent?

A

Rituximab

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14
Q

Hepatitis B core Ab positive, should they receive prophylactic antiviral for rituximab?

A

Oh YES

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15
Q

Hep B core Ab positive, should they receive prophylactic antiviral for biologics and tsDMARD?

A
  1. ACR conditionally recommends monitoring for patients with core Ab positive but surface Ab negative; strongly recommends Rx if both core Ab and surface Ag are positive.
  2. I think both should get prophylactic antiviral
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16
Q

Someone has NAFLD, what should we do for MTX imitation or continuation?

A
  1. If LFT and synthetic function normal, no fibrosis —-> continue MTX
17
Q

On rituximab and has hupoaggamaglobulinemia but no infections, what to do?

A

Continue rituximab

18
Q

Patient has serious infection within 12 months of being considered for RA Rx, what should be the treatment options.

A
  1. Conventional DMARDS
  2. Abatacept

Do NOT use biologics or increased doses of GCs

19
Q

Patient with non-TB mycobacterial infection in RA, what to do with GCs, csDMARD vs biologics, and role of Abatacept

A
  1. GC: either d/c or use at lowest possible dose
  2. CsDMARD over biological (OBVIOULSY!!)
  3. Abatacept of high disease activity in csDMARD
20
Q

What are the 4 criteria included in ACR-EULAR RA criteria

A
  1. Joints
  2. Duration
  3. Inflammatory markers
  4. Serologies
21
Q

What are the 4 joint criteria and how do you score them

A
  1. 1 large joint (0)
  2. 2-10 large joints (1)
  3. 1-3 small joints (3)
  4. 10 joints (at least 1 small joint) (5)
22
Q

What are the 2 criteria for duration of symptoms

A

<6 weeks - 0
>6 weeks - 1

23
Q

What are the two inflammatory markers

A

Normal ESR and CRP - 0
Elevated ESR and CRP - 1

24
Q

What are the three serological criteria for RA EULAR-ACR

A
  1. Negative - 0
  2. Low titre RF/CCP - 2
  3. High titre RF/CCP - 3

Rheum (12 decks)

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