Rheumatoid Arthritis

Question 1

RA - Prodromal Symptoms

Answer 1

fatigue, weakness
fever
weight loss
decreased mood
myalgias

Question 2

RA - Signs

Answer 2

symmetric swelling of hands / wrists / ankles / feet
synovitis, erythematous, warm
rheumatoid nodules present
grip weakness, muscle atrophy

Question 3

RA - Symptoms

Answer 3

occur with use and rest
joint pain and stiffness last > 6 wks
decreased range of motion
joint deformity

Question 4

RA - Complications

Answer 4

hematologic involvement
pulmonary involvement
cardiac involvement
ocular involvement
amyloidosis
vasculitis
osteoporosis

Question 5

RA - Diagnosis

Answer 5

elevated ESR, CRP
elevated rheumatoid factor
elevated ANAs, ACPAs

Question 6

RA - Goals of Therapy

Answer 6

decrease pain, maintain joint mobility, maintain ADLs
slow destructive joint changes
achieve low disease activity

Question 7

RA - Conventional Synthetic DMARDs

Answer 7

methotrexate
leflunomide
hydroxychloroquine
sulfasalazine

Question 8

RA - Biologic TNF Inhibitors

Answer 8

etanercept
infliximab
adalimumab
golimumab
certolizumab

Question 9

RA - Biologic Non-TNF Inhibitors

Answer 9

abatacept
rituximab
tocilizumab
anakinra
sarilumab

Question 10

RA - Targeted Synthetic DMARDs

Answer 10

JAK inhibitors (tofacitinib, baricitinib, upadacitinib)

Question 11

Methotrexate - Adverse Reactions

Answer 11

stomatitis
dyspepsia
immunosuppression

Question 12

Methotrexate - Boxed Warnings

Answer 12

GI toxicity
dermatological reactions
pulmonary fibrosis
myelosuppression
increased LFTs

Question 13

Methotrexate - CIs

Answer 13

pregnancy & breastfeeding
renal & liver disease
immunodeficiency
myelosuppression

Question 14

RA - Methotrexate’s Place in Therapy

Answer 14

first-line treatment, csDMARD of choice
except DMARD-naive with low disease activity

Question 15

Leflunomide - Boxed Warnings

Answer 15

embryofetal toxicity
hepatotoxicity

Question 16

Leflunomide - Adverse Reactions

Answer 16

NVD
alopecia
rash (SJS / TEN potential)
peripheral neuropathy
hypertension

Question 17

Leflunomide - DDIs

Answer 17

warfarin (decreases INR)
inhibits OAT3 and OATP1B1/3

Question 18

Leflunomide - Drug Elimination

Answer 18

with the help of cholestyramine

Question 19

Sulfasalazine - Adverse Reactions

Answer 19

NV, abdominal pain
weight loss
headache
oligospermia
rash, pruritis, urticaria
hemolytic anemia

Question 20

Sulfasalazine - CIs

Answer 20

intestinal or urinary obstruction
porphyria
sulfa allergy

Question 21

Hydroxychloroquine - Adverse Reactions

Answer 21

NVD
irreversible retinal damage
QT prolongation
dermatological reactions

Question 22

Hydroxychloroquine - Monitoring

Answer 22

ophthalmologic exam at baseline and every 3 months

Question 23

Methotrexate - Monitoring

Answer 23

rule out pregnancy and check X-ray at baseline

Question 24

Leflunomide - Monitoring

Answer 24

rule out pregnancy at baseline

Question 25

Sulfasalazine - Monitoring

Answer 25

rule out G6PD deficiency at baseline

Question 26

csDMARD - Monitoring

Answer 26

CBC LFTs SCr

Question 27

DMARD-naive Recommendations - Moderate-to-High Disease Activity

Answer 27

csDMARD monotherapy methotrexate recommended first line

Question 28

DMARD-naive Recommendations - Low Disease Activity

Answer 28

csDMARD monotherapy hydroxychloroquine recommended first line

Question 29

RA - Biologic Therapy Indications

Answer 29

moderate-high disease activity despite csDMARD monotherapy intolerance / CI to csDMARD use in combination with MTX

Question 30

RA - DMARD Recommendations at Target

Answer 30

continue regimen (do not reduce dose) continue at least 1 DMARD must be at target for 6 months before considering dose reduction

Question 31

RA - DMARD Recommendation NOT at Target

Answer 31

try MTX if haven't tried before switch to SQ MTX if used PO before add another csDMARD add bDMARD or tsDMARD

Question 32

TNF Inhibitors - Adverse Reactions

Answer 32

infections injection site reactions URTIs rash

Question 33

TNF Inhibitors - BBWs

Answer 33

malignancy serious infections (TB, sepsis, fungal, opportunistic)

Question 34

Rituximab - Monitoring

Answer 34

CBC with each dose

Question 35

Biologic DMARDs - Monitoring

Answer 35

latent TB at baseline and throughout treatment

Question 36

JAK Inhibitors - BBWs

Answer 36

opportunistic infections malignancies thrombosis

Question 37

JAK Inhibitors - Adverse Reactions

Answer 37

increased HDL / LDL headache URTI infections

Question 38

RA - Drugs to Avoid in Pregnancy

Answer 38

methotrexate leflunomide

Question 39

RA - Drugs to Use in TB

Answer 39

JAK inhibitor or biologic after 1 month of TB treatment

Question 40

RA - Drugs to Use in HF

Answer 40

non-TNF inhibitor or JAK inhibitor

Question 41

RA - Drugs to Use in Lymphoproliferative Disorder

Answer 41

rituximab

Question 42

RA - Drugs to Avoid in Liver Disease

Answer 42

methotrexate leflunomide

Question 43

RA - Vaccines Before Treatment Initiation

Answer 43

pneumococcal influenza hepatitis B HPV live Herpes Zoster