rheumatology

Question 1

oligo

Answer 1

2-4

Question 2

pauci

Answer 2

<5

Question 3

extended pauci

Answer 3

5 or 6

Question 4

poly

Answer 4

> 6

Question 5

enthesis

Answer 5

where mm attach to bone

Question 6

arthropathy

Answer 6

joint deformed

Question 7

diarthrodial joints

Answer 7

joints with synovium

Question 8

what is primarily inflamed in RA

Answer 8

synovium -> synovitis

Question 9

where are rheumatoid factors produces

Answer 9

in affected joints synovium

Question 10

what do the rheumatoid factors do?

Answer 10

fix C’ -> C’ consumed -> C’ fragments recruit and activate PMNs -> Ab prodction

Question 11

what type of hypersensitivity rxn is RA

Answer 11

immune complex type III hypersensitivity

Question 12

phases of RA

Answer 12

initial immune stirrings
pre-symptomatic phase
disease onset
overall 10 year progression

Question 13

initial immune stirrings

Answer 13

RF+
anti-CCP +
increased CRP

Question 14

pre-symptomatic phase

Answer 14

can start to see neutrophil infiltrate in joints

Question 15

disease onset

Answer 15

pain, inflammation, fatigue, damage

Question 16

what are the 2 cytokines most implicated in RA

Answer 16

TNF-alpha

IL-1

Question 17

peak age of onset of RA

Answer 17

25-45

Question 18

what are some other diseases that people with RA are at risk for

Answer 18

infection
renal disease
GI disease
heart disease
malignancy (highest increased risk)

Question 19

what condition has highest associated mortality in RA pts

Answer 19

heart disease

Question 20

RA dx

Answer 20

must have 4 of the following for at least 6wks:

• morning stiffness >1hr
• swelling in 3+ joints
• symmetric joint swelling
• rheumatoid nodules (pathognomonic)
• rheumatoid factor
• erosions or osteopenia on hand x-ray

Question 21

what is the best modality for RA imaging?

Answer 21

US!!

MRI good too, just a lot more expensive

Question 22

common hand deformities of RA

Answer 22

boutonnieres
swan-neck
ulna deviation

Question 23

extra-articular manifestations of RA

Answer 23

rheumatoid noduels
sjogrens
felty syndrome
vasculitis
rheumatoid lung
cardiac disease
neuromyopathy
laboratory
inflammatory eye dis
osteoporosis
lymphadenopathy 
hyperviscosity 
cryoglobulinemia 
dermatologic 
amyloidosis

Question 24

alarming signs of spinal cord damage in RA

Answer 24

diminished motor power in arms and legs
severe neck pain often radiating to occiput
dyesthesias of fingers and feet
marle sensation in limbs and trunk
jumping legs, d/t spinal automatism
disturbed bladder fnx

Question 25

eye diseases of RA

Answer 25

scleritis

scleromalacia

Question 26

sicca syndrome

Answer 26

dry membranes
may or may not be autoimmune
component sjogrens

Question 27

primary sjogrens syndrome

Answer 27

SS-A (Ro)
SS-B (La)
plus Abs

Question 28

schirmers test

Answer 28

place litmus strips on eyes -> should tear up significantly

Question 29

RA labs

Answer 29

RF
anit-CCP Ab
ANA+
elevated ESR or CRP
anemia
thrombocytosis
hyperglobulinemia 
leukopenia/granulocytopenia
low glucose

Question 30

RF

Answer 30

little Dx value, better for prognosis, must be >50 for Dx

anti-CCP better Dx value

Question 31

best way to Dx RA

Answer 31

if both RF and anti-ccp +

Question 32

what are the only two aspects of RA we can Tx

Answer 32

alleviate pain

slow rate of joint damage

Question 33

pros of MTX

Answer 33

once wk
long term clinical experience
favorable rate of continuing therapy
proven efficacy

Question 34

MTX cons

Answer 34

lab monitoring every 4-8: CBC, LFTs, Cr

toxicities: alopecia, hepatic, category x, myelosupression, pulmonary

Question 35

LEF pros

Answer 35

well absorbed PO
early onset of action
stabilized benefit for long term 
selectively targets autoimmune lymphocytes to reduce AEs
rapid excretion w/cholestyramine

Question 36

LEF cons

Answer 36

lack of clinical experience

toxicities: hepatic, GI, teratogenic

Question 37

remission criteria

Answer 37

> 5 of the following for 2+ months

AM stiffness <20 females

Question 38

clinical pearls to managing RA

Answer 38

confirm Dx
define extend of joint involvement 
define extra -articular involvement 
consider co-morbid disease
full dose NSAID
early use of DMARD
add BIO aent
low dose steroids for flares
frequent monitoring