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Flashcards in Rheumatoid arthritis Deck (28):
1

Describe the epidemiology of rheumatoid arthritis

more common in women
peak onset around 50 yrs
highly associated with smoking

2

List the diagnostic criteria for RA

- number and distribution of joints (more points for more joints and small joints)
- serum markers RF and CCP
- ESR/ CRP
- duration > 6 weeks

Sore > 6/10= RA

3

List risk factors for RA

HLA-DR association
smoking

4

Describe the histologic features of RA

synovial inflammation forming a pannus rich with inflammatory cells
vascular proliferation
matrix metaloproteinases eroding bone and cartilage--> marginal erosions

5

____ erosions are characteristic of RA

Marginal

6

What joints are most commonly affected by RA?

PIP, MCP, wrist, MTPs
rarely hips, DIP, lumbar spine

7

List the extra-articular manifestations of RA?

rheumatoid nodules, nail fold infarcts, ulcers due to vasculitis, pleurisy, interstitial lung disease, pericarditis, nodules on heart valves, aortitis, accelerated CV disease, peripheral neuropathy

8

What is Felty's syndrome

neutropenia + splenomegaly

9

What antibody tests are most useful to diagnose RA?

RF (but not specific for RA)
CCP is both sensitive and specific for RA

10

List major goals of RA treatment

- reduce joint pain and inflammation to improve functional status and quality of life,
- prevent bone/cartilage damage including joint erosions
- control systemic inflammation to limit mortality

11

List treatment options for FA

NSAIDs
DMARDs: methotrexate, sulfasalazine, hydroxychloroquine, leflunomide
Biologic agents: TNF-a agents, others

12

______ can be given orally or by intra-articular injection for acute relief from RA but are not used for long term therapy

corticosteroids

13

________ are used in patients who have aggressive arthritis or who have failed one or more DMARD

Biologic agents

14

________ works by subtle immunomodulation without significant immunosuppressive risks

hydroxychloroquine

15

What is the mechanism of hydroxychloroquine?

stabilizes lysosomal membranes, inhibits DNA polymerase, decreases fibronectin, platelet aggregation, histamine production, and IL-1-induced cartilage degradation/cytokine production.

16

What is the mechanism of action of methotrexate?

Inhibits dihydrofolate reductase, thus decreasing cellular turnover in rapidly proliferating cells

17

What are side effects of methotrexate?

aphthous ulcers, stomatitis, alopecia, GI upset, macrocytic anemia, infection risk

18

______ is a major teratogen and is contraindicated in pregnancy

Methotrexate

19

______ is analagous to methotrexate

Leflunomid- inhibits dihydroorotate dehydrogenase essential for pyrimidine syntehsis, anti-proliferative effects

20

_____ is given when patients on leflunomide develop infection, due to the very long half life of the drug

cholestyramine

21

What is the mechanism of action of sulfasalazine

antibacterial and anti-inflammatory

22

What are the components of triple therapy?

Methotrexate + Sulfasalazine + Hydroxychloroquine

23

What steps are necessary before initiating a TNF a agent?

TB test, chest X ray

24

TNF agents block either by ________ or by ______

monoclonal antibodies or receptor blockade

25

______ is a soluble TNF-a receptor that competitively binds TNF

etanercept

26

List some non-TNF biologics

CTLA-4 antagonism: abatacept
B-Cell Antagonism: Rituximab
IL-6 Blockade: Tocilizumab
Kinase Inhibition: Tofacitinib

27

When pain is diffuse and non-articular or muscle based, but strength and CK are normal, consider ________

fibromyalgia

28

What is the therapeutic approach to fibromyalgia?

improving sleep, exercise, pacing meaningful life activities, and non-narcotic pain management.