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