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Ortho-Rheum > RA + Juvenile Idiopathic Arthritis > Flashcards

RA + Juvenile Idiopathic Arthritis Flashcards

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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
what is the NSAID rule for treatment of RA?
use only one NSAID at a time
26
which NSAID can be used to treat RA? what can be used with it to protect gastric mucosa?
naproxen (naprosyn) PPI
27
which NSAID is 2nd line for RA and has less risk of GI bleed?
celecoxib
28
when treatment can be used for pain in RA when NSAIDs are contraindicated? what's an ADR?
acetaminophen liver toxicity
29
what treatment offers the most effective short-term relief for RA, and is used as a bridge until DMARDS starts working?
corticosteroids
30
what do corticosteroids help with in RA?
active disease or flare-ups
31
which corticosteroid can be used for RA? what's an alternative if patient doesn't want to gain weight?
low dose prednisone intra-articular steroid injection
32
what is the mainstay of management in RA?
DMARDs
33
immunosuppressive drugs that reduce M&M by limiting complications, slowing progression of disease, and preserve joint function
DMARDs
34
how long do DMARDs take to work?
6 weeks or longer
35
what are the two 1st line DMARDs used for RA?
methotrexate leflunomide
36
what is the initial DMARDs of choice for RA?
methotrexate
37
how is methotrexate used for RA?
once a week pill OR subcutaneous
38
3 ADRs of methotrexate?
liver toxicity renal toxicity teratogenicity
39
how is leflunomide used for RA?
daily
40
4 ADRs of leflunomide?
liver toxicity teratogenicity alopecia bone marrow suppression
41
what should be monitored when using methotrexate? leflunomide?
liver and renal function liver function
42
what are the 2 alternative DMARDs used for RA?
hydroxychloroquine sulfasalazine
43
which DMARDs requires eye examination, but is okay to use in pregnant women or women planning to become pregnant?
hydroxychloroquine
44
what is hydroxychloroquine dosing based on?
weight
45
what should be checked before treating a patient's RA with sulfasalazine? why?
G6PD risk of hemolysis
46
in which patients should sulfasalazine be avoided? (3)
lupus + sulfa allergy aspirin allergy
47
newer protein drugs used for RA that reduce the signs and symptoms of synovitis
biologics
48
before starting biologics, what should patients be screened for? (2)
TB with Chest Xray hepatitis panel
49
what is the most common type of arthritis seen in kids and teens?
juvenile idiopathic arthritis (JIA)
50
what criteria must be met to diagnose a patient with CHRONIC Juvenile idiopathic arthritis?
chronic inflammatory arthritis > 6 weeks
51
what is the age of onset of juvenile idiopathic arthritis?
younger than 16 yrs
52
what are the 6 types of Juvenile Idiopathic Arthritis?
oligoarthritis polyarthritis systemic juvenile idiopathic arthritis psoriatic enthesis-related undifferentiated
53
the most common JIA that affects 4 or less joints during the duration of the disease
oligoarthritis
54
a 2 year old patient presents with asymmetrical joint pain in the knees, ankles, and wrists and has uveitis. Dx?
oligoarthritis
55
what lab will be positive in oligoarthritis? what does it indicate?
ANA asymptomatic uveitis
56
JIA that affects more than 5 joints during the first 6 months of disease
polyarthritis
57
a patient presents with weight loss, fatigue, low fever, and pain in 6 joints. Dx?
polyarthritis
58
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?
seronegative polyarthritis
59
what is the least common of all JIA?
seropositive polyarthritis
60
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?
seropositive polyarthritis
61
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?
systemic JIA
62
one of the following must be present for a patient to be diagnosed with systemic JIA: (4)
transient erythematous rash lymphadenopathy hepatomegaly/splenomegaly serositis
63
what is the criteria for psoriatic JIA?
**arthritis + psoriasis** *OR* **arthritis + two:** dactylitis nail pitting/onycholysis psoriasis in 1st deg relative
64
a 3 year old patient presents with chronic uveitis. what do they likely have?
psoriatic JIA
65
inflammation at site where tendons and ligaments insert into bones and strongly associated with HLA-B27.
enthesis-related JIA
66
a patient presents with asymmetric peripheral arthritis, anterior uveitis, IBD, and pain in the hip. Dx?
enthesis-related JIA
67
patient meets criteria for more than one subtype or no subtype
undifferentiated
68
what will RF+ patients show in xray late in the course of JIA? (2)
joint space narrowing erosion
69
what is the best imaging tool to detect early bone erosions in JIA?
ultrasound
70
what will help make a definitive diagnosis of JIA?
synovial biopsy
71
what screening test should be done in patients with anterior uveitis?
slit lamp exam (ophthalmological screening)
72
what is the first line treatment for JIA?
Indomethacin (NSAID)
73
what is the second line treatment for JIA?
methotrexate (DMARDs)
74
what can be used to treat JIA if patient does not respond to 3 months of methotrexate?
biologics
75
what is the treatment for polyarthritis JIA with moderate/severe disease activity?
biologics
76
what can be used in JIA for severe systemic involvement, bridge therapy for DMARDs, and for acute anterior uveitis?
short-course systemic steroids
77
what are 3 articular complications associated with JIA?
joint destruction/deformity limb length discrepancy growth retardation
78
what are 2 extra-articular complications associated with JIA?
blindness (chronic anterior uveitis) pericarditis/pleuritis
79
what is a common extra-articular complication of systemic JIA?
macrophage activated syndrome
80
prognosis of JIA?
most resolve by puberty

Ortho-Rheum (27 decks)

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