Rheumatology - Told

Question 1

osteoarthritis

Answer 1

not inflammatory

Question 2

pain

Answer 2

dalor

Question 3

heat

Answer 3

calor

Question 4

rubor

Answer 4

redness

Question 5

swelling

Answer 5

tumor

Question 6

cardinal features of inflammation

Answer 6

dalor, calor, rubor, tumor

also - tenderness, stiffness, crepitation

Question 7

single joint

Answer 7

monoarthritis

Question 8

2-4 joints

Answer 8

oligoarthritis

Question 9

<5 joints

Answer 9

pauci

Question 10

5 or 6 joints

Answer 10

extended pauci

Question 11

> 6 joints

Answer 11

poly arthritis

Question 12

insertion of tendon

Answer 12

enthesis

Question 13

ESR

Answer 13

non protein acute phase reactant - effects plasma viscosity as fibrinogen is consumed

more inflammation - less viscous plasma - more cells fall out of suspension

Question 14

time course of rheumatoid arthritis

Answer 14

10 years from initial immune stirring to disease onset

initial immune stirring - RF, anti-CCP, and elevated CRP

Question 15

rheumatoid factor

Answer 15

auto-Abs - usually IgM

Question 16

complement consumption

Answer 16

in RA joint

Question 17

immunopathology of RA

Answer 17

rheumatoid factor produced by synovium

• RF fixes complement
• complement consumed
• recruit and activates PMNs
• localized immune complex disease

TNF and MAC destroy joint

Question 18

pro-inflammatory

Answer 18

TNF-a and IL-1

Question 19

anti-inflammatory

Answer 19

soluble TNF receptor

IL-1 antagonist

Question 20

epidemiology of RA

Answer 20

more in women
1-2% of population

peak age 25-45yo

Question 21

improves during pregnancy

Answer 21

rheumatoid arthritis

Question 22

associated with RA

Answer 22

infection
renal disease
GI disease
heart disease - recently has gone down
malignancfy

Question 23

diagnosis of RA

Answer 23

4 criteria met

1 - morning stiffness >1 hour*
2 - swelling 3 or more joint areas*
3 - swelling in hand joints*
4 - symmetric joint swelling*
5 - rheumatoid nodules
6 - rheumatoid factor
7 - erosion or osteopenia on hand x-ray
8 - must be present >6 weeks
*longer than 6 months

Question 24

PIP

Answer 24

rheumatoid arthritis

Question 25

DIP

Answer 25

osteoarthritis

Question 26

pannus

Answer 26

infiltrating lymphocytes - seen in rheumatoid arthritis

Question 27

ulnar deviation

Answer 27

rheumatoid arthritis

Question 28

U/S vs. RA

Answer 28

inflammation better seen with ultrasound**

Question 29

imaging in RA

Answer 29

X-ray insensitive MRI - occult erosions, synovial enhancement, synovial thickening

Question 30

boutonniere deformity

Answer 30

in hand with RA enthesitis and rupture

Question 31

swan neck deformity

Answer 31

in hand with RA enthesitis and rupture

Question 32

enthesitis

Answer 32

inflammation where tendon/ligament insert into bone

Question 33

rheumatic nodules

Answer 33

almost pathognomonic of RA | -always RF positive

Question 34

additional mainfestations of RA

Answer 34

``` rheumatoid nodules sjogrens feltys vasculitis rheumatoid lung cardiac neuromyopathy inflammatory eye disease** osteoporosis lymphadenopathy hyperviscosity - DVT cryoglobulinemia dermatologic amyloidosis ```

Question 35

myelopathy in RA

Answer 35

spinal cord damage -no HVLA** ``` neck pain radiates to occiput dysesthesia of fingers and feet marble sensation - limbs and trunk jumping leg disturbed bladder function ```

Question 36

scleritis and scleromalacia

Answer 36

seen with RA | -inflammatory eye disease

Question 37

sicca symptoms

Answer 37

dry eyes, dry mouth, vaginal dryness, tracheo-bronchial dryness sjogrens - can occur with rheumatoid arthritis

Question 38

SS-A

Answer 38

Ro

Question 39

SS-B

Answer 39

La

Question 40

SS-A and SS-B

Answer 40

Ro and La associatd with primary sjogrens

Question 41

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

Answer 41

seen in RA

Question 42

diagnosis of RA based on auto-Abs

Answer 42

RF alone - needs to be very high for diagnosis - not that specific with anti-CCP - increased specificity

Question 43

CCP

Answer 43

cyclic cirtullinated protein

Question 44

good predictor of erosiveness

Answer 44

RF

Question 45

anti-CCP alone

Answer 45

96% specific

Question 46

anti-CCP and RF

Answer 46

98% specific

Question 47

goal of therapy in RA

Answer 47

alleviate pain slow rate of joint damage only things we can do unfortunately

Question 48

pharmacotherapy for RA

Answer 48

``` NSAIDs - toxicity assocation corticosteroids - chronic use - bad DMARD - delayed onset of action biologic - infection and $$$ analgesic - long last opiod - control pain and improve function ```

Question 49

DMARDs

Answer 49

methotrexate leflunomide also hydroxychloroquine, sulfasalazin, gold compounds, azathioprine, cyclosporine

Question 50

category X in pregnancy

Answer 50

leflunomide and methotrexate

Question 51

IL-1 receptor antagonist

Answer 51

anakinra

Question 52

soluble TNF receptor

Answer 52

etanercept

Question 53

anti TNF-a Abs

Answer 53

adalimumab | infliximab

Question 54

once a week dosing

Answer 54

methotrexate

Question 55

early onset of action

Answer 55

leflunomide

Question 56

rapid exretion with cholestyramine

Answer 56

leflunomide

Question 57

goal of tx with RA

Answer 57

AM stiffness 5 criteria must be met >2 consecutive months

Question 58

co-morbid disease in RA

Answer 58

lung and eyes

Question 59

low dose steroids

Answer 59

for flares of RA

Question 60

biologic agent

Answer 60

only if non-biologics fail