RA, OA, PMR And Fibromyalgia Flashcards by Lauren F

Should we give opioids for fibromyalgia

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Subchondral bone thickening with degeneration of cartilage

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What is the most specific autoantibody for RA

Anti CCP

Specificity is 90-98%

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What will the labs look like in PMR

Elevated ESR

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Will people with RA have trouble opening jars?

Yes, they have reduced grip strength and ROM

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How long does morning stiffness last with RA and what makes it better?

Lasts over an hour and gets better with movement

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Is the onset of polymyalgia rheumatica progressive or sudden?

Sudden***

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What kinds of external triggers might wake up a genetic predisposition for RA?

SMOKING

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Enthesitis with chronic inflammation

Ankylosing Spondylitis

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What is the most common inflammatory arthritis?

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What are the primary joints affected in RA?

MCP and PIP

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What is the main nonbiologic DMARD used in RA

Methotrexate

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More common in women

Chronic, generalized pain

Fatigue

Sleep and mood disturbances

Headaches

IBS

Multiple tender areas

No inflammatory muscle or joint disease

Labs unremarkable

Fibromyalgia

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What are the main types of biologic DMARDs used in RA?

TNF inhibitors

Non-TNF inhibitors

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What is the treatment of RA?

DMARDS in all patients

Quit smoking

PT/OT

Rest if needed

NSAIDS

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What are the primary joints affected in OA?

DIP

1st CMC

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Is RA symmetrical

Yes**

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Does the joint space narrow in OA

Yes and it can be seen on x ray

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What is the treatment for PMR?

Low dose steroids!!

PROFOUND RESPONSE

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How do DMARDs help RA

Slow/halt disease progression and preserves joint function

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What will you see on an X-ray of OA

Joint space narrowing

Osteophytes ***

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How do you treat OA

Weight loss **

Oral and topical NSAIDs

Topical capsaicin

Cymbalta

Steroid injections

Tramadol

Tylenol

Opioids sparingly if at all
**know all of these

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What causes the compression on the cervical spinal cord in RA

Inflammation (?)

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“I hurt all over”. “It feels like i always have the flu”

Fibromyalgia

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What is the most common joint disorder

Is the DIP joint affected in OA

Yes

Are there any specific labs for OA

No Negative RF and anti-CCP Normal ESR and CRP

How long will morning stiffness last in OA

Less than 30 min

What is the difference between OA and greater trochanteric pain syndrome

GTPS will usually be more lateral with point tenderness

What is a pathognomic sign of OA

Osteophytes (bone spurs)

What is seronegative RA?

RA that lacks both RF and anti-CCP antibodies but otherwise is characteristic of RA in every other way

Is RA a gradual onset

Yes, RA pts will have gradual difficulty with ADL’s like walking, dressing, toileting, etc

Is carpal tunnel syndrome a complication of RA?

Yes because the inflammation makes the tunnel smaller

Is osteoarthritis an autoimmune disease?

No it is a degenerative disease

Is CAD associated with RA?

Yes, the inflammation may increase atherosclerosis

Which has extra-articular manifestations: OA or RA?

What is the preferred initial imaging study for RA

X ray

Which type of arthritis causes an inflamed synovium?

Who should be tested for RA?

Have at least 1 joint with definite synovitis Synovitis not better explained by another disease

Is OA usually symmetrical or asymmetrical

Asymmetrical

What is it: Autoimmune disease that is chronic, systemic, inflammatory that primarily involves the synovial joints with extraarticular manifestations

“No matter how much i sleep, it’s like i got hit by a truck”

Fibromyalgia -they always feel unrefreshed even after sleeping for 8-10hrs

How will the joints appear in OA

Hard and bony

Name it: | Synovial hypertrophy with chronic joint inflammation

Is OA just wear and tear of the cartilage

No, it involves all of the joint tissues (cartilage, bone, ligaments and synovium)

“I suddenly can’t brush my hair or put on my bra or pull shirt over my head”

Polymyalgia rheumatica

Does RA involve constitutional symptoms like fatigue, myalgia, fever, weight loss

Yes

Which way do the fingers deviate in RA

Ulnar

When would we use MRI in the assessment of RA

When looking at cervical spine

What are all the things you need to know about PMR

- women - over 50 - steroids are 1st line- profound response - sudden, recent change - giant cell arteritis - elevated ESR

What are the classic symptoms in classic locations for RA

Pain, stiffness and swelling In the small joints of the hands, wrists and forefoot

What are the 2 types of DMARDS

Nonbiologic “traditional” Biologic

Does OA affect the synovial membrane or the soft tissue components of the joint?

Yes

What condition is polymyalgia rheumatica associated with

``` Giant cell (temporal) arteritis ******** ```

Which has more morning stiffness: RA or OA?

Why do you need to order both RF and anti-CCP labs for RA?

One or the other may be negative, but if they are both positive, it really suggests RA

Does RA affect the DIP joints?

NO!!!*********

What is Felty syndrome and what causes it?

It’s a triad of RA, splenomegaly and neutropenia | *********

How does RA cause cervical myelopathy?

The C1 - C2 joint is unstable and may subluxate causing impingement on the cord

Which type of arthritis has Heberdens nodes?

What is it: | Progressive loss and destruction of cartilage**************

OA CARTILAGE EROSION BONE SPURS

RA usually spares the axial skeleton, except for which part?

The cervical spine! C1 and C2

How will the joints appear in RA?

Soft Warm Tender

What is the most common site for rheumatoid nodules to appear

Elbow

What kinds of bony changes will be seen in the joint in OA

Bone sclerosis (bone thickening) Osteophytes (bone spurs)

What 2 labs do you need to order when diagnosing RA

Rheumatoid factor Anti-CCP antibodies

Who is more likely to get polymyalgia rheumatica

Women of Northern European descent over 50

When should DMARDs be started in RA

As early as possible

What are some controversial treatments for OA

Intrarticular hyaluronic acid Glucosamine/chondroitin

How does RA affect the popliteal fossa

Bakers cysts common

What is the nonpharmacologic treatment for fibromyalgia

Exercise (especially water aerobics) PT Behavioral therapy

Is secondary Sjögren’s syndrome a manifestation of RA

Yes

Which type of arthritis involves cartilage loss

Do you see swan neck and boutonnière deformities in RA?

Yes

What will you see on X-ray of RA

PIP joint erosions Periarticular osteopenia Joint space narrowing Soft tissue swelling around joint

What is it: Proximal** aching and stiffness in the shoulder, pelvic girdle and neck Over 50 years old Women of Northern European descent

Polymyalgia rheumatica (PMR)

How does RA affect the feet

Common to see bunions and hammer toes

What is thought to cause the symptoms of polymyalgia rheumatica?

Nonerosive synovitis and tenosynovitis

Is fibromyalgia true inflammation

What makes OA worse and what makes it better?

Activity makes it worse Rest makes it better

What will analysis of the synovial fluid in RA reveal?

Inflammatory effusion

What is the leading cause of chronic disability in old people

How does the pain present in polymyalgia rheumatica (PMR)

Sudden Bilateral Shoulders and hips Morning stiffness/gel phenomenon

What do you need to do before starting DMARDs?

Check a bunch of labs, give them vaccines, check their eyes and test for TB since the medication can cause malignancy/infection

What are the classic findings on the hands in OA

Bilateral Heberdens nodes Bouchards nodes First carpometacarpal joint Often “squared off” due to CMC having osteophytes

What is the treatment for fibromyalgia

Antidepressants- amitriptyline Anticonvulsants - gaba SNRIs- cymbalta or savella

What are the locations of the joints usually affected by RA?

Many joints on both sides, starting with the peripheral joints to more proximal. Axial skeleton spared except for cervical spine

When does the stiffness of OA get worse?

After effort “Evening stiffness”

Who usually gets RA?

Women between 35 and 50

What are two words you can use to describe the swollen joints of RA?

Boggy Fluctuance

What is a marker of disease severity in RA?

How many extraarticular manifestations you have

What parts of the spine are affected in OA

Cervical and Lumbar | RA was just cervical

What makes RA worse and what makes it better?

Rest makes it worse Activity makes it better

RA, OA, PMR And Fibromyalgia Flashcards

(93 cards)