Rheumatology and RA, Told, Part I

Question 1

what are the seronegative spondylarthropathies

Answer 1

ankylosing spondylitis
psoriatic arthritis
reactive arthritis

Question 2

what arthritis is not inflammatory

Answer 2

osteo

it is degenerative

Question 3

what are the cardinal signs of inflammation

Answer 3

pain
heat
redness
swelling

Question 4

what are the additional cardinal signs of inflammation for arthritis

Answer 4

tenderness, stiffness, crepitation, functional impairment

Question 5

monoarthritis

Answer 5

one joint

Question 6

olig arthritis

Answer 6

2-4

Question 7

pauci arthritis

Answer 7

<5 joints

Question 8

poly arthritis

Answer 8

6+

Question 9

what is the enthesis

Answer 9

where muscle jionts bone

Question 10

what is an example of diarthrodial joint

Answer 10

knee

Question 11

general characteristics of RA

Answer 11

chronic
systemic
non suppurative
inflammatory
arthropathy
diarthrodial joints
extra aticular

Question 12

what are the acute phase reactants in inflammation

Answer 12

APR and CRP

fibrinogen

Question 13

The greater inflammation what happens to plasma

Answer 13

less viscous

cells fall out of suspension

Question 14

What occurs in diarthrodial joint in RA

Answer 14

bursitis, tendinitis, synovitis

Question 15

what are initial lab signs of RA

Answer 15

FR +
anti CCP +
increased CRP

Question 16

disease onset of RA Sx

Answer 16

pain, inflammation, fatigue and damage, usually 10 years brewing

Question 17

types of autoAb that RF is

Answer 17

IgM

Question 18

what type of autoimmune reaction is RA

Answer 18

localized immune complex from the RF produced and C’ consumed

Question 19

What immune cell is responsible for damage in RA

Answer 19

T cells, CD8 CTL kill everything, MAC complex

Question 20

what are the main pro inflammatory cytokines

Answer 20

TNF a

IL 1

Question 21

what are the main anti inflammatory cytokines

Answer 21

IL4 IL10 IL11 IL13

Question 22

when does RA peak age

Answer 22

25-45

Question 23

pregnancy and RA

Answer 23

improves during pregnancy

Question 24

mortality from RA

Answer 24

infection! and heart disease, malignancy

Question 25

ACR classification for RA

Answer 25

4 of these for more than 6 weeks* ``` morning stiffness >1 hour* swelling in 3+ joints* swelling in hand joints* symmetric joint swelling* rheumatoid nodules rheumatoid factor erosions or osteopenia on hands x rays ```

Question 26

RA attacks what joints commonly

Answer 26

MCPs PIPs, knee, ankle, subtalar, MTPs

Question 27

OA attacks what joints commonly

Answer 27

medial knee, DIP

Question 28

loss of what cells in synovium from RA knee

Answer 28

loss of goblet cells

Question 29

ulnar deviation

Answer 29

RA

Question 30

joint space narrowing and erosions in fingers

Answer 30

RA

Question 31

what imaging is most useful with Dx of RA

Answer 31

US!! MRI, plain radiographs

Question 32

what imaging study shows inflammation

Answer 32

US

Question 33

best imaging for detecting tenosynovitis

Answer 33

US MRI

Question 34

synovitis hallmark

Answer 34

increased synovial volume

Question 35

what is boutonniere deformity

Answer 35

rupture extensor retinaculum DIP stuck in extension PIP in flexion MCP in extension

Question 36

what is swan neck deformity

Answer 36

rupture of extensor digitorum profundus MCP and PIP extended DIP flexed

Question 37

extra articular manifestations of RA

Answer 37

``` rheumatoid nodules sjogrens syndrome feltys syndrome vasculitis rheumatoid lung cardiac disease neuromyopathy lab tests inflammatory eye Dx osteoporosis lymphadenopathy hyperviscosity cryoglobulinemia dermatologic amyloidosis ```

Question 38

what sign of RA is always indicative of a RF+ patient

Answer 38

rheumatoid nodules

Question 39

what ligament can be dangerously compromised in RA

Answer 39

transverse ligament of atlas keeps C1 on C2

Question 40

what are alarming signs of spinal cord damage in RA

Answer 40

``` diminished motor power in arms and legs severe neck pain often radiating to occiput dysesthesias of fingers and feet marble sensation in limbs and trunk jumping legs from spinal automatism disturbed bladder function ```

Question 41

what does scleritis look like

Answer 41

swelling of sclera | assoc with RA

Question 42

what is scleromalacia

Answer 42

blue spots seen in sclera

Question 43

What are Sicca Sx

Answer 43

dry eyes dry mouth vaginal dryness tracheo-bronchial dryness

Question 44

primary sjogrens syndrome is assoc with what

Answer 44

SSA (Ro) and SS-B (La) Ab

Question 45

Tx sjogrens

Answer 45

Tx symptoms

Question 46

shirmers test

Answer 46

eye strips to lower eyelid to see if lacrimal fluid comes out

Question 47

lab findings in RA

Answer 47

``` +RF +anti CCP + ANA elevated ESR or CRP anemia thrombocytosis hyperglobulinemia leukopenia, granulocytopenia glucose in body fluids- very low ```

Question 48

goals of therapy in RA

Answer 48

``` control disease activity alleviate pain slow rate of joint damage maintain function maximize quality of life reduce premature mortality ```

Question 49

non Rx Tx RA is usefule when

Answer 49

early and late phase RA

Question 50

limitations to RX Tx for RA

Answer 50

cost | toxicity- corticosteroids, NSAIDs, DMARDs, biologic agents

Question 51

biologic agents risk factor

Answer 51

opportunistic infections