Rheumatoid Arthritis Flashcards Preview

724: Medical Lectures > Rheumatoid Arthritis > Flashcards

Flashcards in Rheumatoid Arthritis Deck (31)
1

Rheumatoid arthritis is an autoimmune disorder whose main manifestation is in what types of joints?

multiple synovitis joints

2

Is RA more common in men or women?

women

3

What are the pathologic findings in a RA joint?

Chronic synovitis with the formation of a pannus

4

What is a pannus?

It is abnormal granulation tissue that erodes cartilage, bone, ligaments, and tendons

5

What are the characteristics of acute phase RA?

Effusion and warmth

6

What are the characteristics of late phase RA?

Fibrous ankylosis

7

RA has an _____ onset with vague periarticular pain or stiffness.

insidious

8

Stiffness associated with RA persists for at least __ minutes in the morning

30

9

What joints does RA typically affect?

- PIP joints of the fingers
- MCP joints
- wrists
- knees
- ankles
- MTP joints

10

What may also occur with RA?

Synovial cysts and rupture of tendons

11

Does RA affect the spine?

It can affect the neck, but spares the remainder of the spine. In advanced RA patients AA subluxation is possible, which leads to death (Important to keep in mind during surgery).

12

__% of patients have RA nodules

20

13

Where do RA nodules predominate?

- Bony prominences
- Bursae
- Tendon sheaths
- Lungs
- Sclerae

14

What type of ocular symptoms are seen in patients with advanced RA?

- Dryness of eyes, mouth and other mucous membranes
- Episcleritis
- Scleritis
- Scleromalacia

15

What are other symptoms associated with RA?

- Interstitial lung disease
- Pericarditis and pleural disease
- Small vessel vasculitis
- Necrotizing arteritis
- Felty syndrome
- Aortitis

16

Anti-CCP antibodies and Rheumatoid factor are present in __-__% of patients with established RA

70-80

17

Which lab finding is the most specific blood test for RA?

Anti-CCP antibodies

18

What percentage of RA patients have antinuclear antibodies (ANA)?

20%

19

When is an arthrocentesis required?

When a patient with RA has one joint inflamed out of proportion to the rest in order to detect septic arthritis

20

Of all laboratory tests, which is the most specific to RA?

imaging

21

What are some differential diagnoses of RA?

- Osteoarthritis
- CPPD arthritis
- Gouty arthritis
- Spondyloarthropathies
- Chronic Lyme disease
- Human parvovirus B 19 infection
- Hepatitis C
- SLE
- Polymyalgia rheumatica
- Rheumatic fever
- Cancers

22

What are the 3 objectives to treating RA?

- reduction of inflammation and pain
- preservation of function
- prevention of deformity

23

What type of pharmacologic intervention should be started ASAP?

Disease-modifying antirheumatic drugs (DMARDs)

24

What are often used as a "bridge" to reduce disease activity until the slower acting DMARDs take effect?

corticosteroids

25

What are the 6 types of synthetic DMARDs?

- Methotrexate
- Sulfasalazine
- Leflunomide
- Antimalarials
- Minocyline
- Tofacitinib

26

What are the 4 types of biologic DMARDs?

- Tumor Necrosis Factor Inhibitors
- Abatacept
- Rituximab
- Tocilizumab

27

As a general rule, DMARDs have greater efficacy when administered how?

in combination rather than when used individually

28

What is the most commonly used combination of DMARDs to treat RA?

methotrexate with one of the TNF inhibitors

29

What are the 5 most common deformities that occur in patients with RA?

- ulnar deviation of the fingers
- boutonnière deformity
- “swan-neck” deformity
- valgus deformity of the knee
- volar subluxation of the MTP joints

30

The excess mortality associated with rheumatoid arthritis is largely due to what?

cardiovascular disease that appears to be a result of deleterious effects of chronic systemic inflammation on the vascular system

31

What is essential for appropriate diagnosis and the timely introduction of effective therapy?

Early referral to a rheumatologist