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Flashcards in Rheumatoid Arthritis Deck (39):
1

What structures does rheumatoid arthritis affect?

any synovial joint- both articular and extra-articular structures

2

What is rheumatoid arthritis?

symmetrical inflammatory arthritis affecting mainly peripheral joints

3

Who does rheumtaoid arthritis affect?

any age group; M:F is 1:3

4

What is RA mediated by?

HLA-DR4

5

What causes RA?

unknown but potential triggers: infections; stress; cigarette smoking

6

What are the synovial joints in the body?

C1/C2 in spine; hands joints; wrists; elbows; shoulders; TMJs; knees; hips; ankles

7

What is a pannus?

formation of granulation/fibrovascular tissue at the edges of synovial lining

8

What cytokines do macrophages produce in RA?

TNF-alpha; IL-1; IL-6

9

What do B cells produce in RA?

RF; IL-6

10

What do IL-6; TNF; IL-1; made by macrophages and B cells stimulate chondrocytes to produce?

matrix- metalloproteinases

11

Why do the distal interphalangeal joints tend not to be affected by RA?

not enough synovium in that joint

12

What is early RA defined as?

less than 2 years since symptom onset

13

Why are the first 3 months of RA critical?

therapeutic window of opportunity

14

What are the 1987 criteria for RA?

morning stiffness; arthritis of 3 or more joint areas; arthritis of hand joints; symmetric arthritis; rheumatoid nodules; serum RF; radiographic changes

15

Why is the 1987 criteria for RA outdated?

not all pts get rheumatoid nodules; RF is not always present; radiographic changes only in later disease etc

16

What are the 4 areas in the 2010 criteria for RA?

joint distribution
serology (RF and ACPA)
symptom duration (more or less than 6 weeks)
acute phase reactants (CRP and ESR)

17

Why is there morning stiffness with RA?

increased synovial viscosity

18

What is the squeeze test?

positive cmopression (squeeze) test of metacarpophalngeal and metatarsophalangeal joints

19

What is trigger finger?

inflam around tendon sheaths of finer means finger gets stuck bent

20

What hspprnd in carpal tunnel syndrome?

compression of medial nerve in the wrist; thumb, index and middle finer are numb and painful

21

What is palindromic rheumatism?

variant of RA which is episodic and can progress to RA; more commonly caused by gout and pseudogout

22

What are the systemic symptoms seen in RA?

weight loss
night sweats
anorexia
rheumatoid cachexia

23

What are the 2 auto-antibodies seen with RA?

rheumatoid factor (IgM)
antibodies to cyclic citrullinated peptide

24

Why is it pointless to continue testing antibodies?

antibodies remain positive despite treatment

25

What is seen on X-ray of RA?

soft tissue swelling; periarticular osteopaenia; erosions

26

What is osteopenia?

decrease in bone density- blacker bone, due to increase in osteoclastic activity

27

What is the disadvantage of X-rays?

absence of findings in early disease

28

What is US good for?

increased sensitivity for synovitis in early disease

29

When are NSAIDs and steroids used in the treatment of RA?

adjuncts; as DMARDs take 6 weeks to work so NSAIDs and steroids help manage symptoms

30

What is first line DMARD in RA treatment?

methotrexate

31

What 3 drugs are used in combination therapy?

methotrexate; sulfasalazine; hydroxychloroquine

32

Why do you need to do a baseline CXR before starting a pt on methotrexate?

risk of pneumonitis

33

Why do LFTs have to be monitored regularly?

the DMARDs can all cause hepatotoxicity

34

What should be discussed with females before starting DMARDs?

drugs are teratrogenic

35

When should sulfasalzine be avoided?

in septrin allergy and G6PD deficiency

36

What are the biologic agents that can be employed in RA?

anti-TNF; T cell receptor blockers; B cell depletor; IL 6 blocker

37

What do you have to screen for before starting a pt on biologic agents?

TB; hep B; hep C; HIV; varicella zoster

38

What can happen to the spine in severe RA?

atlanto-axial subluxation

39

Why can RA cause mortality?

accelerated CVS disease